1619025210 NPI number — MARY J EWING SLP

Table of content: MARY J EWING SLP (NPI 1619025210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619025210 NPI number — MARY J EWING SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EWING
Provider First Name:
MARY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1619025210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 N TILLOTSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-3988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-288-1928
Provider Business Mailing Address Fax Number:
765-741-0335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14901 CAREY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46033-6000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-407-3422
Provider Business Practice Location Address Fax Number:
877-407-4329
Provider Enumeration Date:
01/08/2007

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:  22003762A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201251830 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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