1639301179 NPI number — MRS. ALISON DAWN SOPHER MACCC/SLP

Table of content: MRS. ALISON DAWN SOPHER MACCC/SLP (NPI 1639301179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639301179 NPI number — MRS. ALISON DAWN SOPHER MACCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOPHER
Provider First Name:
ALISON
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MACCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
ALISON
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MACCC/SLP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639301179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 DARLINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER FALLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15010-1305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-846-8255
Provider Business Mailing Address Fax Number:
724-647-1232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 DARLINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAVER FALLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15010-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-846-8255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2009

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:  SL006153L , 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)

  • Identifier: 1023932040001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".