1215190038 NPI number — GRAYSON VERNER BINOTTI MS, CCC-SLP

Table of content: GRAYSON VERNER BINOTTI MS, CCC-SLP (NPI 1215190038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215190038 NPI number — GRAYSON VERNER BINOTTI MS, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BINOTTI
Provider First Name:
GRAYSON
Provider Middle Name:
VERNER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, 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:
ADAMS
Provider Other First Name:
GRAYSON
Provider Other Middle Name:
VERNER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215190038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO DRAWER 2109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
429-967-2322
Provider Business Mailing Address Fax Number:
479-967-2876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5701 SPRINGHILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72015-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-653-2255
Provider Business Practice Location Address Fax Number:
501-653-2257
Provider Enumeration Date:
07/02/2008

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

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

  • Identifier: 168955721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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