1376603944 NPI number — MRS. VEARL DEAN GALVIN DELSOL EDD LCPC

Table of content: MRS. VEARL DEAN GALVIN DELSOL EDD LCPC (NPI 1376603944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376603944 NPI number — MRS. VEARL DEAN GALVIN DELSOL EDD LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALVIN DELSOL
Provider First Name:
VEARL
Provider Middle Name:
DEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
EDD LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALVIN DELSOL
Provider Other First Name:
VEARL
Provider Other Middle Name:
DEAN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376603944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 LAKE ST
Provider Second Line Business Mailing Address:
SUITE 519
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-551-4140
Provider Business Mailing Address Fax Number:
630-551-4170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 LAKE ST
Provider Second Line Business Practice Location Address:
SUITE 519
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-551-4140
Provider Business Practice Location Address Fax Number:
630-551-4170
Provider Enumeration Date:
12/12/2006

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: 101Y00000X , 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)

  • Identifier: 0009932407 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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