1316006497 NPI number — MS. NANCY LYNN GIRMSCHEID LCSW

Table of content: AMANDA EVETTE VITAL BGS, M.A.T., ED.S. (NPI 1275039588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316006497 NPI number — MS. NANCY LYNN GIRMSCHEID LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIRMSCHEID
Provider First Name:
NANCY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODEN
Provider Other First Name:
NANCY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316006497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
373 ILLINI DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-274-4995
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 E EUREKA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61530-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-467-3770
Provider Business Practice Location Address Fax Number:
309-467-5356
Provider Enumeration Date:
12/06/2006

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: 1041C0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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