1821136995 NPI number — JENNIFER LEA PARKER NEELY MSCCCSLP

Table of content: JENNIFER LEA PARKER NEELY MSCCCSLP (NPI 1821136995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821136995 NPI number — JENNIFER LEA PARKER NEELY MSCCCSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEELY
Provider First Name:
JENNIFER
Provider Middle Name:
LEA PARKER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSCCCSLP
Provider Gender Code:
F

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:
1821136995
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:
1011 HONOR HEIGHTS DR
Provider Second Line Business Mailing Address:
MAIL CODE 118
Provider Business Mailing Address City Name:
MUSKOGEE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74401-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-781-8578
Provider Business Mailing Address Fax Number:
918-781-8541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VAMC 1011 HONOR HEIGHTS DRIVE
Provider Second Line Business Practice Location Address:
MAIL CODE 117W
Provider Business Practice Location Address City Name:
MUSKOGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-781-8578
Provider Business Practice Location Address Fax Number:
918-781-8541
Provider Enumeration Date:
02/02/2007

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

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





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