1265893820 NPI number — STEPHANIE QUINN DE ROO NCC, LMHC (T), MS

Table of content: STEPHANIE QUINN DE ROO NCC, LMHC (T), MS (NPI 1265893820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265893820 NPI number — STEPHANIE QUINN DE ROO NCC, LMHC (T), MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE ROO
Provider First Name:
STEPHANIE
Provider Middle Name:
QUINN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NCC, LMHC (T), MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUINN
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265893820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 2ND AVE SE
Provider Second Line Business Mailing Address:
SUITE NUMBER 205
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52403-2368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 2ND AVE SE
Provider Second Line Business Practice Location Address:
SUITE NUMBER 205
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52403-2368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-739-5325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2016

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: 101YM0800X , with the licence number:  079136 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com