1750461703 NPI number — LISA JANE UTHELL SLP

Table of content: LISA JANE UTHELL SLP (NPI 1750461703)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750461703 NPI number — LISA JANE UTHELL SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UTHELL
Provider First Name:
LISA
Provider Middle Name:
JANE
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:
1750461703
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:
16800 N 1650TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEUTOPOLIS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62467-3267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-857-1120
Provider Business Mailing Address Fax Number:
217-857-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16800 N 1650TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEUTOPOLIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62467-3267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-857-1120
Provider Business Practice Location Address Fax Number:
217-857-1120
Provider Enumeration Date:
10/16/2006

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: 235Z00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 656108 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 02532021 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".