1144351594 NPI number — MRS. LYNSEY LEE BATES MS CCCSLP

Table of content: MRS. LYNSEY LEE BATES MS CCCSLP (NPI 1144351594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144351594 NPI number — MRS. LYNSEY LEE BATES MS CCCSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BATES
Provider First Name:
LYNSEY
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCCSLP
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:
1144351594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
173 PATTERSON LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71730-8477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-863-3367
Provider Business Mailing Address Fax Number:
870-863-3367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1616 NORTH VINE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAGNOLIA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71753-9740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-234-8979
Provider Business Practice Location Address Fax Number:
870-234-0118
Provider Enumeration Date:
03/08/2007

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:  SP2136 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 156170721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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