1558560557 NPI number — LYNN RYAN MORAN SLP

Table of content: LYNN RYAN MORAN SLP (NPI 1558560557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558560557 NPI number — LYNN RYAN MORAN SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN
Provider First Name:
LYNN
Provider Middle Name:
RYAN
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:
1558560557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 307
Provider Second Line Business Mailing Address:
3666 WILHELM ROAD
Provider Business Mailing Address City Name:
HELLERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18055-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-838-7969
Provider Business Mailing Address Fax Number:
610-838-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 N BELFIELD AVE
Provider Second Line Business Practice Location Address:
SUNNY DAYS
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-449-1600
Provider Business Practice Location Address Fax Number:
610-449-2655
Provider Enumeration Date:
07/11/2007

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:  SL000709L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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