1669482691 NPI number — MRS. JILLIAN KATHRINE GOLDER M.S., CCC-SLP

Table of content: MRS. JILLIAN KATHRINE GOLDER M.S., CCC-SLP (NPI 1669482691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669482691 NPI number — MRS. JILLIAN KATHRINE GOLDER M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDER
Provider First Name:
JILLIAN
Provider Middle Name:
KATHRINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOGGAN
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
KATHRINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669482691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37092
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85740-7092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-818-1646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SOUTHERN ARIZONA VA HEALTH CARE SYSTEM
Provider Second Line Business Practice Location Address:
3601 S. 6TH AVE.
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85723-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-792-1450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2006

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:  SLP4168 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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