1598886111 NPI number — MS. KELLI MURDOCK EICKELBERG MA, CCC-SLP

Table of content: MS. KELLI MURDOCK EICKELBERG MA, CCC-SLP (NPI 1598886111)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598886111 NPI number — MS. KELLI MURDOCK EICKELBERG MA, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EICKELBERG
Provider First Name:
KELLI
Provider Middle Name:
MURDOCK
Provider Name Prefix Text:
MS.
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:
1598886111
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7701 SW CIRRUS DRIVE, SUITE 32-D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97008-5966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-520-5030
Provider Business Mailing Address Fax Number:
503-520-5090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7701 SW CIRRUS DRIVE, SUITE 32-D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97008-5966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-520-5030
Provider Business Practice Location Address Fax Number:
503-520-5090
Provider Enumeration Date:
04/02/2007

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:  10960 , 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: 10960 . This is a "OREGAON STATE LICENSE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: LL60802215 . This is a "WA STATE LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".