1285997874 NPI number — MRS. ANGELA JEAN PIKUL M.S.CCC/SLP

Table of content: MRS. ANGELA JEAN PIKUL M.S.CCC/SLP (NPI 1285997874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285997874 NPI number — MRS. ANGELA JEAN PIKUL M.S.CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIKUL
Provider First Name:
ANGELA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.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:
RIVECCA
Provider Other First Name:
ANGELA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. CCC/SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285997874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 WOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITESBORO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13492-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-736-9561
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 FISHER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOHAWK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13407-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-866-4851
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2012

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:  000964-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com