1497703854 NPI number — PATRICIA JEAN RUMMEL LCSW

Table of content: (NPI 1184058810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497703854 NPI number — PATRICIA JEAN RUMMEL LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUMMEL
Provider First Name:
PATRICIA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IRWIN
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497703854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 N HARRISON ST
Provider Second Line Business Mailing Address:
ATTN: ANNE LAWSON
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46580-3163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-267-7169
Provider Business Mailing Address Fax Number:
574-268-2377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBION
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46701-1438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-636-6884
Provider Business Practice Location Address Fax Number:
260-636-3392
Provider Enumeration Date:
05/05/2006

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: 1041C0700X , with the licence number:  6801072921 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34004214A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100163580 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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