1871647321 NPI number — MRS. MICHELE GAIL ELFRINK SLP

Table of content: MRS. MICHELE GAIL ELFRINK SLP (NPI 1871647321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871647321 NPI number — MRS. MICHELE GAIL ELFRINK SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELFRINK
Provider First Name:
MICHELE
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
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:
PETERS
Provider Other First Name:
MICHELE
Provider Other Middle Name:
GAIL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871647321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2064B WALTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63755-3701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-204-0429
Provider Business Mailing Address Fax Number:
573-204-0471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3264 COUNTY ROAD 316
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63701-9122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-450-1272
Provider Business Practice Location Address Fax Number:
573-651-0210
Provider Enumeration Date:
01/22/2007

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:  109856 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 469392419 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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