1285658179 NPI number — MRS. GAYLE LINDSAY SLATEN HERMAN M.S., MFT

Table of content: MRS. GAYLE LINDSAY SLATEN HERMAN M.S., MFT (NPI 1285658179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285658179 NPI number — MRS. GAYLE LINDSAY SLATEN HERMAN M.S., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERMAN
Provider First Name:
GAYLE
Provider Middle Name:
LINDSAY SLATEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARONE
Provider Other First Name:
GAYLE
Provider Other Middle Name:
LINDSAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285658179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 W HERRON BOULEVARD KP N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEBAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98349-8186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-783-7254
Provider Business Mailing Address Fax Number:
253-884-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 W HERRON BOULEVARD KP N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEBAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98349-8186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-783-7254
Provider Business Practice Location Address Fax Number:
253-884-1248
Provider Enumeration Date:
07/26/2006

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: 106H00000X , with the licence number:  MFC24750 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: LF00002663 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A137329 . This is a "VALUE OPTIONS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1021-02 . This is a "PACIFICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ56345Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001067987 . This is a "MHN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".