1902027592 NPI number — BRITTNEY DANIELLE BAIRD REIDY CCC-A

Table of content: BRITTNEY DANIELLE BAIRD REIDY CCC-A (NPI 1902027592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902027592 NPI number — BRITTNEY DANIELLE BAIRD REIDY CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REIDY
Provider First Name:
BRITTNEY
Provider Middle Name:
DANIELLE BAIRD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAIRD
Provider Other First Name:
BRITTNEY
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902027592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19662
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62794-9662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-545-6099
Provider Business Mailing Address Fax Number:
217-545-0253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N 8TH ST
Provider Second Line Business Practice Location Address:
PAV 5B
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-545-6099
Provider Business Practice Location Address Fax Number:
217-545-0253
Provider Enumeration Date:
05/01/2007

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: 231H00000X , with the licence number:  147-001220 , 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)





Copyright © 2007-2024 www.npivalidator.com