1912906884 NPI number — MRS. DAWN ELAINE IRWIN-GROLEAU M.ED, CCC-SLP

Table of content: MRS. DAWN ELAINE IRWIN-GROLEAU M.ED, CCC-SLP (NPI 1912906884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912906884 NPI number — MRS. DAWN ELAINE IRWIN-GROLEAU M.ED, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRWIN-GROLEAU
Provider First Name:
DAWN
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
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:
1912906884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1135 OLDE W CHOCOLATE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUMMELSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17036-9188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-833-5305
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 OLDE W CHOCOLATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMMELSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17036-9188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-833-5305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2005

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:  SL004120L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01849420 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20036905 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02249901 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: IR1300111 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2586470 . This is a "AETNA US HEALTHCARE HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1537903 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7083250 . This is a "AETNA US HEALTHCARE PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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