1467050443 NPI number — SPEECH THERAPY & ALLIED RESOURCES, PLLC

Table of content: TYLER WILLIAM JONES APRN (NPI 1124651344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467050443 NPI number — SPEECH THERAPY & ALLIED RESOURCES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH THERAPY & ALLIED RESOURCES, PLLC
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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1467050443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
811 9TH ST
Provider Second Line Business Mailing Address:
STE 120, #266
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 ENGLEWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27701-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-703-9675
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DESENA
Authorized Official First Name:
KRISTEN
Authorized Official Middle Name:
KESLER
Authorized Official Title or Position:
OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
248-703-9675

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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