1881973345 NPI number — MS. THEKLA MARGARET VONHAGKE LPC

Table of content: MS. THEKLA MARGARET VONHAGKE LPC (NPI 1881973345)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881973345 NPI number — MS. THEKLA MARGARET VONHAGKE LPC

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
VONHAGKE

Provider First Name:
THEKLA

Provider Middle Name:
MARGARET

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
LPC

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:
1881973345

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
04/29/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11390

Provider Second Line Business Mailing Address:
610 W. BROADWAY, SUITE L 1

Provider Business Mailing Address City Name:
JACKSON

Provider Business Mailing Address State Name:
WY

Provider Business Mailing Address Postal Code:
83002-1390

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
307-733-3908

Provider Business Mailing Address Fax Number:
307-733-0017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 W BROADWAY AVE

Provider Second Line Business Practice Location Address:
SUITE L 1

Provider Business Practice Location Address City Name:
JACKSON

Provider Business Practice Location Address State Name:
WY

Provider Business Practice Location Address Postal Code:
83001-8213

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
307-733-3908

Provider Business Practice Location Address Fax Number:
307-733-0017

Provider Enumeration Date:
08/15/2011

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: 101YM0800X , with the licence number: LPC 408 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .