1225479157 NPI number — MRS. KEELY DEANNA LAWLER SABAINI BCBA, M.S.

Table of content: MRS. KEELY DEANNA LAWLER SABAINI BCBA, M.S. (NPI 1225479157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225479157 NPI number — MRS. KEELY DEANNA LAWLER SABAINI BCBA, M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAWLER SABAINI
Provider First Name:
KEELY
Provider Middle Name:
DEANNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA, M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWLER
Provider Other First Name:
KEELY
Provider Other Middle Name:
DEANNA
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225479157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
418 E ADAMS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
O FALLON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62269-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-781-0720
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 E ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62269-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-781-0720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2013

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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