1134863939 NPI number — CPETERS01

Table of content: MS. JAMY CHRISTINE SNYDER BHRS (NPI 1255607974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134863939 NPI number — CPETERS01

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPETERS01
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134863939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9653 DOVER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTLEY
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60142-2431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-960-7706
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1138 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALGONQUIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60102-3482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-960-7706
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
COURTNEY
Authorized Official Middle Name:
ERIN
Authorized Official Title or Position:
OWNER/ CLINICAL THERAPIST
Authorized Official Telephone Number:
773-960-7706

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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