1043430036 NPI number — MARY JANE SONNTAG PSYD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043430036 NPI number — MARY JANE SONNTAG PSYD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY JANE SONNTAG PSYD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER FOR STRESS REDUCTION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043430036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 HALSTED CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-631-6400
Provider Business Mailing Address Fax Number:
479-631-6466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 HALSTED CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-631-6400
Provider Business Practice Location Address Fax Number:
479-631-6466
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SONNTAG
Authorized Official First Name:
MARY
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
479-631-6400

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5C136 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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