1649608043 NPI number — EMILY MARIE MAYERHOFER MS, CGC

Table of content: EMILY MARIE MAYERHOFER MS, CGC (NPI 1649608043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649608043 NPI number — EMILY MARIE MAYERHOFER MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYERHOFER
Provider First Name:
EMILY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANDBERG
Provider Other First Name:
EMILY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CGC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649608043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 CENTRACARE CIR
Provider Second Line Business Mailing Address:
2375
Provider Business Mailing Address City Name:
ST CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-654-3654
Provider Business Mailing Address Fax Number:
320-654-3696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 CENTRACARE CIR
Provider Second Line Business Practice Location Address:
2375
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-654-3654
Provider Business Practice Location Address Fax Number:
320-654-3696
Provider Enumeration Date:
10/22/2013

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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