1124489844 NPI number — JENELLE GUCWA CCC SLP

Table of content: JENELLE GUCWA CCC SLP (NPI 1124489844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124489844 NPI number — JENELLE GUCWA CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUCWA
Provider First Name:
JENELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEFFIELD
Provider Other First Name:
JENELLE
Provider Other Middle Name:
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:
1124489844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22593 THREE NOTCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALIFORNIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20619-3054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
18-622-5053
Provider Business Mailing Address Fax Number:
301-862-2548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22593 THREE NOTCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALIFORNIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20619-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
18-622-5053
Provider Business Practice Location Address Fax Number:
301-862-2548
Provider Enumeration Date:
03/08/2016

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:  110900 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 09344 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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