1831314657 NPI number — JACQUELINE E MCLEOD MA,SLP

Table of content: JACQUELINE E MCLEOD MA,SLP (NPI 1831314657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831314657 NPI number — JACQUELINE E MCLEOD MA,SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLEOD
Provider First Name:
JACQUELINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA,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:
1831314657
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:
6376 W ROXBURY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80128-4674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-922-8855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6595 S DAYTON ST
Provider Second Line Business Practice Location Address:
SUITE 1500
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-6128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-504-9945
Provider Business Practice Location Address Fax Number:
303-504-9946
Provider Enumeration Date:
04/16/2007

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 29577039 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 649046 . This is a "ANTHEM" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com