1386812691 NPI number — JANE A. POPE

Table of content: (NPI 1386812691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386812691 NPI number — JANE A. POPE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JANE A. POPE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JANE A. POPE D.B.A SLP SERVICES
Provider Other Organization Name Type Code:
3
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:
1386812691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4798 ANDREW ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-922-8870
Provider Business Mailing Address Fax Number:
618-964-9038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4798 ANDREW ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-922-8870
Provider Business Practice Location Address Fax Number:
618-964-9038
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
POPE
Authorized Official First Name:
JANE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SPEECH/LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
618-922-8870

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  146007402 , 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)





Copyright © 2007-2024 www.npivalidator.com