1508886862 NPI number — KATHERINE ELAINE STRENGTH MA SLP CCC

Table of content: KATHERINE ELAINE STRENGTH MA SLP CCC (NPI 1508886862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508886862 NPI number — KATHERINE ELAINE STRENGTH MA SLP CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRENGTH
Provider First Name:
KATHERINE
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA SLP CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENFIELD
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA SLP-CCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508886862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 WINTERBERRY DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-389-2950
Provider Business Mailing Address Fax Number:
706-389-2951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 BAXTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-389-2950
Provider Business Practice Location Address Fax Number:
706-389-2951
Provider Enumeration Date:
07/20/2006

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 , with the licence number:  SLP005809 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003133488A . This is a "CIS NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 12025668 . This is a "NATIONAL ASHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 016408833A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SLP005809 . This is a "STATE LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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