1295858264 NPI number — ELIZABETH DAIL PARKER M.S., CCC-SLP

Table of content: ELIZABETH DAIL PARKER M.S., CCC-SLP (NPI 1295858264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295858264 NPI number — ELIZABETH DAIL PARKER M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
ELIZABETH
Provider Middle Name:
DAIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., 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:
CLINE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
DAIL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295858264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1504 SW 8TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66606-1632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-232-8533
Provider Business Mailing Address Fax Number:
785-232-8580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1504 SW 8TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-232-8533
Provider Business Practice Location Address Fax Number:
785-232-8580
Provider Enumeration Date:
04/06/2007

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:  2639 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 068002291 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".