1063667970 NPI number — TENDER ONES THERAPY SERVICES, INC.

Table of content: LINDSAY JAN GONZALEZ M.S. CCC-SLP (NPI 1609070416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063667970 NPI number — TENDER ONES THERAPY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDER ONES THERAPY SERVICES, INC.
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:
Provider Other Organization Name Type Code:
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:
1063667970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2089 TERON TRCE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
DACULA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30019-1609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-904-6009
Provider Business Mailing Address Fax Number:
770-904-2357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2089 TERON TRCE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
DACULA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30019-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-904-6009
Provider Business Practice Location Address Fax Number:
770-904-2357
Provider Enumeration Date:
11/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
NOREEN
Authorized Official Middle Name:
VICTORIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-904-6009

Provider Taxonomy Codes

  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 812641509A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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