1801921366 NPI number — MRS. EMILY F GREEN MS CCC SLP

Table of content: MRS. EMILY F GREEN MS CCC SLP (NPI 1801921366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801921366 NPI number — MRS. EMILY F GREEN MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
EMILY
Provider Middle Name:
F
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS 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:
1801921366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
906 SOUTH ST
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65785-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-276-6161
Provider Business Mailing Address Fax Number:
417-276-3765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
906 SOUT ST
Provider Second Line Business Practice Location Address:
STOCKTON R-I SCHOOL DISTRICT
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65785-0190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-276-6161
Provider Business Practice Location Address Fax Number:
417-276-3765
Provider Enumeration Date:
02/23/2007

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:  2004002564 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 466036100 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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