1316947252 NPI number — LAURA MICHIE SLP

Table of content: LAURA MICHIE SLP (NPI 1316947252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316947252 NPI number — LAURA MICHIE SLP

Organization/Personal Information

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

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:
1316947252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 N JEFFERSON ST
Provider Second Line Business Mailing Address:
STE 304
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21701-4866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-471-3169
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 N JEFFERSON ST
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21701-4866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-668-1852
Provider Business Practice Location Address Fax Number:
301-668-1854
Provider Enumeration Date:
07/21/2005

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:  01642 , 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)

  • Identifier: 5060511 . This is a "AETNA NON HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510BDO-81032101 . This is a "CAREFIRST BLUECROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 273799 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: T615-0005 . This is a "CAREFIRST BLUECHOICE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 216682996 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2118118 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".




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