1235475997 NPI number — MS. ELISE RENEE HANCOCK M.S., CCC-SLP

Table of content: MS. ELISE RENEE HANCOCK M.S., CCC-SLP (NPI 1235475997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235475997 NPI number — MS. ELISE RENEE HANCOCK M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANCOCK
Provider First Name:
ELISE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

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:
1235475997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 CONGRESS ST # 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISVILLE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05661-6049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-279-5847
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 POND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05855-4825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-279-5847
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12069791 . This is a "AMERICAN SPEECH AND HEARING ASSOCIATION" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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