1528560158 NPI number — KELLY LOUISE SINCLAIR-MCCLINTOCK MA, LICDC

Table of content: KELLY LOUISE SINCLAIR-MCCLINTOCK MA, LICDC (NPI 1528560158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528560158 NPI number — KELLY LOUISE SINCLAIR-MCCLINTOCK MA, LICDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINCLAIR-MCCLINTOCK
Provider First Name:
KELLY
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LICDC
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:
1528560158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
372 CAPE MAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTE VEDRA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32081-4348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-705-7908
Provider Business Mailing Address Fax Number:
330-244-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5553 FULTON DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-1728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-705-6989
Provider Business Practice Location Address Fax Number:
330-244-1106
Provider Enumeration Date:
02/28/2018

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: 101YA0400X , with the licence number:  981226 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com