1336326065 NPI number — MRS. ALICIA DAWN LETT MACCC SLP

Table of content: MRS. ALICIA DAWN LETT MACCC SLP (NPI 1336326065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336326065 NPI number — MRS. ALICIA DAWN LETT MACCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LETT
Provider First Name:
ALICIA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MACCC 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:
1336326065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SOURWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANIELS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-763-3082
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 ADAIR ST
Provider Second Line Business Practice Location Address:
RALEIGH COUNTY BOARD OF EDUCATION
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-256-4500
Provider Business Practice Location Address Fax Number:
304-256-4739
Provider Enumeration Date:
01/24/2008

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:  WV SLP 0580 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7402230000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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