1609901917 NPI number — ROSEMARY AYRES, MS, CCC-SLP

Table of content: SATISH K CHOUDHARY MD (NPI 1669429841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609901917 NPI number — ROSEMARY AYRES, MS, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEMARY AYRES, MS, CCC-SLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPEECH CAMP
Provider Other Organization Name Type Code:
3
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:
1609901917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1492
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILOMATH
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97370-1492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-929-4568
Provider Business Mailing Address Fax Number:
541-929-4513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 S 12TH STR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILOMATH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97370-1492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-929-4568
Provider Business Practice Location Address Fax Number:
541-929-4513
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AYRES
Authorized Official First Name:
ROSEMARY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
SPEECH PATHOLOGIST, OWNER
Authorized Official Telephone Number:
541-929-4568

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  10192 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y6967-01 . This is a "PACIFICSOURCE HEALTHCARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 138396 . This is a "OMAP-OFFICE MEDICAL ASSIS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 14951000 . This is a "REGENT BLUE CROSS BLUE SH" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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