1427019785 NPI number — MISS JACQUELINE L PHILLIPS M.ED. SLP

Table of content: MISS JACQUELINE L PHILLIPS M.ED. SLP (NPI 1427019785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427019785 NPI number — MISS JACQUELINE L PHILLIPS M.ED. SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
JACQUELINE
Provider Middle Name:
L
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.ED. 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:
1427019785
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:
519 TRENTON ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20032-3867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-361-7887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6506 LOISDALE RD
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22150-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-924-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2006

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: 235Z00000X , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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