1467766469 NPI number — JEANNE A T NORRIS SLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467766469 NPI number — JEANNE A T NORRIS SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORRIS
Provider First Name:
JEANNE
Provider Middle Name:
A T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1467766469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALUDA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23149-0205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-758-2277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2911 GENERAL PULLER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALUDA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23149-3052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-815-8329
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2010

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:  2202006073 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 493302 . This is a "MEDICARE A" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004909976 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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