1679691703 NPI number — LIFE SPIRIT SPEECH PATHOLOGY INC

Table of content: MS. BRENDA L. HAMBY ARNP (NPI 1689600124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679691703 NPI number — LIFE SPIRIT SPEECH PATHOLOGY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFE SPIRIT SPEECH PATHOLOGY INC
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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Middle Name:
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NPI Number Information

NPI Number:
1679691703
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26284 OSO RD
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-842-9557
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26284 OSO RD
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
SAN JUAN CAPISTRANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92675-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-842-9557
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUTCHISON
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
949-842-9557

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  14538 , 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)





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