1912197948 NPI number — CHARLA DEITER

Table of content: (NPI 1912197948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912197948 NPI number — CHARLA DEITER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLA DEITER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1912197948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1711 N 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARKANSAS CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67005-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-442-8700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7733 FORSYTH BLVD STE 1700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63105-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-677-1238
Provider Business Practice Location Address Fax Number:
314-863-0769
Provider Enumeration Date:
07/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEITER
Authorized Official First Name:
CHARLA
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
620-442-8700

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2434 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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