1225281728 NPI number — ELIZABETH ANNE TEMPLE MSW

Table of content: ELIZABETH ANNE TEMPLE MSW (NPI 1225281728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225281728 NPI number — ELIZABETH ANNE TEMPLE MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEMPLE
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1225281728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6489
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46660-6489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-472-6700
Provider Business Mailing Address Fax Number:
574-472-6746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 W 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 100-A
Provider Business Practice Location Address City Name:
MISHAWAKA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46544-1948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-252-0369
Provider Business Practice Location Address Fax Number:
574-252-3694
Provider Enumeration Date:
10/28/2008

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: 171M00000X , with the licence number:  34004291A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34004291A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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