1679702245 NPI number — MICHELLE JILL COX-PORTER PA

Table of content: MRS. REBECCA ELISA ROSADO-WOOLFE M.A., CCC-SLP (NPI 1619114204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679702245 NPI number — MICHELLE JILL COX-PORTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COX-PORTER
Provider First Name:
MICHELLE
Provider Middle Name:
JILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1679702245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 N THUNDERBIRD CIR
Provider Second Line Business Mailing Address:
STE 303
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85215-1214
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:
351 CYPRESS CREEK RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-250-8199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2009

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: 363A00000X , with the licence number:  PA07834 , 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: 0271765 . This is a "STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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