1508117227 NPI number — CHERIE LYNN BARNSTABLE LCSW

Table of content: CHERIE LYNN BARNSTABLE LCSW (NPI 1508117227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508117227 NPI number — CHERIE LYNN BARNSTABLE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNSTABLE
Provider First Name:
CHERIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZEITLER
Provider Other First Name:
CHERIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508117227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97470-0254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-440-3532
Provider Business Mailing Address Fax Number:
541-440-3554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 W MADRONE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97470-3090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-440-3532
Provider Business Practice Location Address Fax Number:
541-440-3554
Provider Enumeration Date:
09/20/2012

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: 1041C0700X , with the licence number:  L5521 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500650114 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".