1669660619 NPI number — JESSICA ANN SCHAUER HERRERA CCC-SLP

Table of content: JESSICA ANN SCHAUER HERRERA CCC-SLP (NPI 1669660619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669660619 NPI number — JESSICA ANN SCHAUER HERRERA CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRERA
Provider First Name:
JESSICA
Provider Middle Name:
ANN SCHAUER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
SCHAUER
Provider Other First Name:
JESSICA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669660619
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GANADO
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86505-0029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-755-3404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
294 W CARLOS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLBROOK
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86025-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-755-1020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2007

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:  RPE4441 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SLP5646 . This is a "AZ STATE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: RPE4441 . This is a "CALIFORNIA SLAB" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".