1144302910 NPI number — ELIZABETH EMILY INKINEN-JUERGENSEN MS.ED PCC-S

Table of content: ELIZABETH EMILY INKINEN-JUERGENSEN MS.ED PCC-S (NPI 1144302910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144302910 NPI number — ELIZABETH EMILY INKINEN-JUERGENSEN MS.ED PCC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INKINEN-JUERGENSEN
Provider First Name:
ELIZABETH
Provider Middle Name:
EMILY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS.ED PCC-S
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:
1144302910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 N BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44308-1910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-535-8181
Provider Business Mailing Address Fax Number:
330-535-9303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 N. BROADWAY ST.
Provider Second Line Business Practice Location Address:
SUMMIT PSYCHOLOGICAL ASSOCIATES, INC.
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-535-8181
Provider Business Practice Location Address Fax Number:
330-535-9303
Provider Enumeration Date:
10/20/2006

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: 101YP2500X , with the licence number:  C0006898 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: E0006898 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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