1396886123 NPI number — MRS. RONDA JOLOYCE LOVELACE MS CCC-SLP

Table of content: MR. GERALD H. PRICE P.T. (NPI 1205163912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396886123 NPI number — MRS. RONDA JOLOYCE LOVELACE MS CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVELACE
Provider First Name:
RONDA
Provider Middle Name:
JOLOYCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAY
Provider Other First Name:
RONDA
Provider Other Middle Name:
JOLOYCE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396886123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2530 BROADWAY AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55906-4594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-259-7570
Provider Business Mailing Address Fax Number:
888-624-3107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2746 SUPERIOR DR NW
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55901-8343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-288-0064
Provider Business Practice Location Address Fax Number:
507-288-3993
Provider Enumeration Date:
02/12/2007

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:  7182 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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