1407877327 NPI number — MRS. KRISTIN ANN TENNEY-BLACKWELL M.A., TLLP

Table of content: MRS. KRISTIN ANN TENNEY-BLACKWELL M.A., TLLP (NPI 1407877327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407877327 NPI number — MRS. KRISTIN ANN TENNEY-BLACKWELL M.A., TLLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TENNEY-BLACKWELL
Provider First Name:
KRISTIN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., TLLP
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:
1407877327
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 N JEFFERSON ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
MARSHALL
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49068-1552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-781-4443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N JEFFERSON ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
MARSHALL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49068-1552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-781-4443
Provider Business Practice Location Address Fax Number:
269-781-4120
Provider Enumeration Date:
07/23/2006

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: 103TC2200X , with the licence number:  6301013134 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TB0200X , with the licence number: 6301013134 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TF0000X , with the licence number: 6301013134 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC0700X , with the licence number: 6301013134 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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