1649429101 NPI number — MRS. VERONICA PAULSON MCCLANE BSW, MHPP

Table of content: MRS. VERONICA PAULSON MCCLANE BSW, MHPP (NPI 1649429101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649429101 NPI number — MRS. VERONICA PAULSON MCCLANE BSW, MHPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLANE
Provider First Name:
VERONICA
Provider Middle Name:
PAULSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BSW, MHPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAULSON
Provider Other First Name:
VERONICA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PLMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649429101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2411 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72076-4211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-982-5402
Provider Business Mailing Address Fax Number:
501-982-5404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2411 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72076-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-982-5402
Provider Business Practice Location Address Fax Number:
501-982-5404
Provider Enumeration Date:
09/09/2008

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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