1649318890 NPI number — MS. KAREN JACKSON PARRISH M.ED. CCC-SLP

Table of content: MS. KAREN JACKSON PARRISH M.ED. CCC-SLP (NPI 1649318890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649318890 NPI number — MS. KAREN JACKSON PARRISH M.ED. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARRISH
Provider First Name:
KAREN
Provider Middle Name:
JACKSON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED. 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:
1649318890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9804
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27429-0804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-541-8167
Provider Business Mailing Address Fax Number:
336-294-8091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 W MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27403-1455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-541-8167
Provider Business Practice Location Address Fax Number:
336-294-8091
Provider Enumeration Date:
02/01/2007

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:  1174 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7465596 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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