1376819771 NPI number — ANNIE TATE MA, CCC SLP

Table of content: ANNIE TATE MA, CCC SLP (NPI 1376819771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376819771 NPI number — ANNIE TATE MA, CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATE
Provider First Name:
ANNIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, 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:
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:
1376819771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
561 WEST 7TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-225-4558
Provider Business Mailing Address Fax Number:
651-225-9474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1260 WEST COUNTY ROAD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDEN HILLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-639-0942
Provider Business Practice Location Address Fax Number:
651-639-1718
Provider Enumeration Date:
03/29/2012

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:  8501 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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