1053503839 NPI number — MRS. JANET ELIZABETH HAY LCPC

Table of content: MRS. JANET ELIZABETH HAY LCPC (NPI 1053503839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053503839 NPI number — MRS. JANET ELIZABETH HAY LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAY
Provider First Name:
JANET
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAY
Provider Other First Name:
JANET
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053503839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3701 E LAKE CTR
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
QUINCY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62305-5842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-653-5454
Provider Business Mailing Address Fax Number:
217-221-9398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3701 E LAKE CTR
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
QUINCY
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62305-5842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-653-5454
Provider Business Practice Location Address Fax Number:
217-221-9398
Provider Enumeration Date:
08/15/2007

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: 101YP2500X , with the licence number:  180005333 , 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: 11537510 . This is a "CAQH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0000132022 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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