1861868416 NPI number — MIRANDA CHRISTIAN HOUSKA SLP

Table of content: MIRANDA CHRISTIAN HOUSKA SLP (NPI 1861868416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861868416 NPI number — MIRANDA CHRISTIAN HOUSKA SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSKA
Provider First Name:
MIRANDA
Provider Middle Name:
CHRISTIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
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:
1861868416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1830 E BROADWAY BLVD
Provider Second Line Business Mailing Address:
SUITE 124-143
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85719-5966
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-232-2021
Provider Business Mailing Address Fax Number:
520-232-2553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2260 N ROSEMONT BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85712-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-232-2021
Provider Business Practice Location Address Fax Number:
520-232-2553
Provider Enumeration Date:
08/18/2015

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 AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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