1275789109 NPI number — MRS. SARAH ALLISON RUSHING CCC-SLP

Table of content: ERANDI MADUSHANI HERATH MD (NPI 1740177997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275789109 NPI number — MRS. SARAH ALLISON RUSHING CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUSHING
Provider First Name:
SARAH
Provider Middle Name:
ALLISON
Provider Name Prefix Text:
MRS.
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:
GORE
Provider Other First Name:
SARAH
Provider Other Middle Name:
ALLISON
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CCC-SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1275789109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2809 HIGHWAY 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE HALL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-692-0443
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 WEST HOLLAND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE HALL
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-247-3698
Provider Business Practice Location Address Fax Number:
870-247-3707
Provider Enumeration Date:
08/12/2008

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:  SP#2219 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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