1386758381 NPI number — MS. CRYSTAL KAY DOVER M.A., CCC-SLP

Table of content: MS. CRYSTAL KAY DOVER M.A., CCC-SLP (NPI 1386758381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386758381 NPI number — MS. CRYSTAL KAY DOVER M.A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOVER
Provider First Name:
CRYSTAL
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., 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:
1386758381
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:
111 ROTUNDA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28806-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-259-9649
Provider Business Mailing Address Fax Number:
828-254-8887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 MERRIMON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-254-8889
Provider Business Practice Location Address Fax Number:
828-254-8887
Provider Enumeration Date:
08/18/2006

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: 235Z00000X , with the licence number:  527 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7401091 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185278 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 141PG . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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