1922566090 NPI number — ERICKA DANAE CONLEY MSW CANDIDATE

Table of content: ERICKA DANAE CONLEY MSW CANDIDATE (NPI 1922566090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922566090 NPI number — ERICKA DANAE CONLEY MSW CANDIDATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONLEY
Provider First Name:
ERICKA
Provider Middle Name:
DANAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW CANDIDATE
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:
1922566090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 DARBY CREEK RD STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40509-1605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-227-2337
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 DARBY CREEK RD STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-227-2337
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2019

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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