1689002487 NPI number — MRS. THERESA LYNN MIHALIC MOSHER M.S., L.G.C.

Table of content: MRS. THERESA LYNN MIHALIC MOSHER M.S., L.G.C. (NPI 1689002487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689002487 NPI number — MRS. THERESA LYNN MIHALIC MOSHER M.S., L.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSHER
Provider First Name:
THERESA
Provider Middle Name:
LYNN MIHALIC
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., L.G.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIHALIC MOSHER
Provider Other First Name:
THERESA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., L.G.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1689002487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 CHILDRENS DR
Provider Second Line Business Mailing Address:
TIMKEN HALL 235
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43205-2664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-722-2478
Provider Business Mailing Address Fax Number:
614-722-3546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 CHILDRENS DR
Provider Second Line Business Practice Location Address:
TIMKEN HALL 235
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43205-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-722-2478
Provider Business Practice Location Address Fax Number:
614-722-3546
Provider Enumeration Date:
10/15/2013

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: 170300000X , with the licence number:  70.000062 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com