1346223427 NPI number — DR. ELIZABETH ELLEN SPERRY SC.D., CCC-SLP

Table of content: DR. ELIZABETH ELLEN SPERRY SC.D., CCC-SLP (NPI 1346223427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346223427 NPI number — DR. ELIZABETH ELLEN SPERRY SC.D., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPERRY
Provider First Name:
ELIZABETH
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
SC.D., 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:
1346223427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11970 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
SUITE 270
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75243-3768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-331-1900
Provider Business Mailing Address Fax Number:
972-331-1909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11970 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-3768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-331-1900
Provider Business Practice Location Address Fax Number:
972-331-1909
Provider Enumeration Date:
11/22/2005

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 , with the licence number:  19138 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 167330301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com