1396997177 NPI number — PATRICIA SCHRODT REITZ CCC/A

Table of content: PATRICIA SCHRODT REITZ CCC/A (NPI 1396997177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396997177 NPI number — PATRICIA SCHRODT REITZ CCC/A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REITZ
Provider First Name:
PATRICIA
Provider Middle Name:
SCHRODT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC/A
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:
1396997177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MANNING DR
Provider Second Line Business Mailing Address:
DEPT OF SPEECH AND AUDIOLOGY
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27514-4220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-843-0425
Provider Business Mailing Address Fax Number:
919-966-8690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MANNING DR
Provider Second Line Business Practice Location Address:
G0303 NEUROSCIENCES, DEPT OF AUDIOLOGY AND SPEECH PATH
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27514-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-843-0425
Provider Business Practice Location Address Fax Number:
919-966-8690
Provider Enumeration Date:
10/13/2008

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: 231H00000X , with the licence number:  5276 , 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)