1891197554 NPI number — JESSICA FAITH TIMPE MA,CCC,SLP

Table of content: JESSICA FAITH TIMPE MA,CCC,SLP (NPI 1891197554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891197554 NPI number — JESSICA FAITH TIMPE MA,CCC,SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMPE
Provider First Name:
JESSICA
Provider Middle Name:
FAITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA,CCC,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:
1891197554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 HICKORY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43558-1125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-250-2805
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 S REYNOLDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43615-6314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-535-0524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2014

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:  SP11832 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0849916 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com