1932598125 NPI number — DR. CASSANDRA PETERS-JOHNSON PHD, CCC-SLP

Table of content: MR. MICHAEL EUGENE ANDREWS P.T. (NPI 1821327073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932598125 NPI number — DR. CASSANDRA PETERS-JOHNSON PHD, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERS-JOHNSON
Provider First Name:
CASSANDRA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, 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:
1932598125
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10607 GREAT ARBOR DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-4220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-613-1986
Provider Business Mailing Address Fax Number:
301-765-9558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10607 GREAT ARBOR DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
POTOMAC
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20854-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-613-1986
Provider Business Practice Location Address Fax Number:
301-765-9558
Provider Enumeration Date:
01/12/2015

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 , with the licence number:  000299 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 00685 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00172254 . This is a "AMERICAN SPEECH-LANGUAGE-HEARING ASSOC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 000299 . This is a "DC HEALTH & REGULATION LICENSING ADMINISTRATION BOARD OF AUD & SPEECH-LANG PATH" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 00685 . This is a "BOARD OF EXAMINERS FOR AUDS, HADS, AND SLPS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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