1023174794 NPI number — MRS. AMY L.F. CHOUINARD MA CCC-SLP

Table of content: MRS. AMY L.F. CHOUINARD MA CCC-SLP (NPI 1023174794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023174794 NPI number — MRS. AMY L.F. CHOUINARD MA CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOUINARD
Provider First Name:
AMY
Provider Middle Name:
L.F.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA 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:
1023174794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9048 PEONY LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE GROVE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55311-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-416-9313
Provider Business Mailing Address Fax Number:
763-416-4530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9048 PEONY LN N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55311-4417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-416-9313
Provider Business Practice Location Address Fax Number:
763-416-4530
Provider Enumeration Date:
12/28/2006

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:  7076 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 46-00528 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 84491 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41M63CH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".