1336627348 NPI number — NICHOLE CARRASQUILLO STUMPF MS, SLP-CCC

Table of content: MISS DENISE ANNE HAMEL LMP (NPI 1346442233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336627348 NPI number — NICHOLE CARRASQUILLO STUMPF MS, SLP-CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUMPF
Provider First Name:
NICHOLE
Provider Middle Name:
CARRASQUILLO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, SLP-CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARRASQUILLO
Provider Other First Name:
NICHOLE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S. SLP-CCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336627348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
265 S PALMER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOLINGBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60490-2126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-200-9474
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 S PALMER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLINGBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60490-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-200-9474
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2018

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:  146.014363 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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