1699774307 NPI number — ERIC RICHARD SLOTH M.A., CCC-SLP

Table of content: ERIC RICHARD SLOTH M.A., CCC-SLP (NPI 1699774307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699774307 NPI number — ERIC RICHARD SLOTH M.A., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOTH
Provider First Name:
ERIC
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-SLP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699774307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 HAYRACK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALGONQUIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60102-6376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-458-4918
Provider Business Mailing Address Fax Number:
847-458-2042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 HAYRACK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALGONQUIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60102-6376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-458-4918
Provider Business Practice Location Address Fax Number:
847-458-2042
Provider Enumeration Date:
07/15/2005

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

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

  • Identifier: ES68741200P . This is a "EARLY INTERVENTION #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 05632026 . This is a "BLUECROSSBLUESHIELD #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 12027348 . This is a "ASHA MEMBER #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1654575 . This is a "TEACHER CERTIFICATE #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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