1457701393 NPI number — MISS JONNEL REID SLP-A

Table of content: MISS JONNEL REID SLP-A (NPI 1457701393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457701393 NPI number — MISS JONNEL REID SLP-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REID
Provider First Name:
JONNEL
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
SLP-A
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:
1457701393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 NE 25TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34470-7034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-401-7916
Provider Business Mailing Address Fax Number:
352-368-7607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 NE 25TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34470-7034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-401-7916
Provider Business Practice Location Address Fax Number:
352-368-7607
Provider Enumeration Date:
06/21/2016

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: 235Z00000X , with the licence number:  SI1957 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SI1957 . This is a "SPEECH PATHOLOGY ASSISTANT LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com