1932283470 NPI number — THERESA L SONDERMAN SLP

Table of content: THERESA L SONDERMAN SLP (NPI 1932283470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932283470 NPI number — THERESA L SONDERMAN SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SONDERMAN
Provider First Name:
THERESA
Provider Middle Name:
L
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:
DOLL
Provider Other First Name:
THERESA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932283470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8337 HARVARD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAYTOWN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64138-3662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-695-1171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 NE PARKS VIEW CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64064-2353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-588-3782
Provider Business Practice Location Address Fax Number:
816-350-7668
Provider Enumeration Date:
10/24/2006

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 , with the licence number:  2005016222 , 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: 36262011 . This is a "BCBS - OT" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 36262021 . This is a "BCBS - OC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".