1063701704 NPI number — MRS. ASHLEY ELIZABETH ANDERSON M.A.

Table of content: MRS. ASHLEY ELIZABETH ANDERSON M.A. (NPI 1063701704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063701704 NPI number — MRS. ASHLEY ELIZABETH ANDERSON M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
ASHLEY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063701704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 EAST 162ND ST. SUITE 209
Provider Second Line Business Mailing Address:
HERITAGE CENTER: REFUGE CHRISTIAN COUNSELING
Provider Business Mailing Address City Name:
SOUTH HOLLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60473-2237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-339-2769
Provider Business Mailing Address Fax Number:
708-339-6776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 E 162ND ST STE 209
Provider Second Line Business Practice Location Address:
HERITAGE CENTER: REFUGE CHRISTIAN COUNSELING
Provider Business Practice Location Address City Name:
SOUTH HOLLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60473-2237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-339-2769
Provider Business Practice Location Address Fax Number:
708-339-6776
Provider Enumeration Date:
04/04/2011

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: 101Y00000X , with the licence number:  178.006667 , 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)





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