1346481025 NPI number — STEPHANIE COLLINS BA IN PSYCHOLOGY

Table of content: STEPHANIE COLLINS BA IN PSYCHOLOGY (NPI 1346481025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346481025 NPI number — STEPHANIE COLLINS BA IN PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
STEPHANIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BA IN PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEINKLE
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346481025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 COWING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97381-2317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-666-3808
Provider Business Mailing Address Fax Number:
503-666-6835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 NE DIVISION ST
Provider Second Line Business Practice Location Address:
# 100
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030-4617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-666-3808
Provider Business Practice Location Address Fax Number:
503-666-6835
Provider Enumeration Date:
03/10/2009

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: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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