1962559054 NPI number — WASHINGTON STATE UNIVERSITY

Table of content: (NPI 1962559054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962559054 NPI number — WASHINGTON STATE UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON STATE UNIVERSITY
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:
SPEECH AND HEARING CLINIC
Provider Other Organization Name Type Code:
5
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:
1962559054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DAGGY HALL, ROOM 133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PULLMAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99164-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-335-1509
Provider Business Mailing Address Fax Number:
509-335-8357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DAGGY HALL, ROOM 133
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99164-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-335-1509
Provider Business Practice Location Address Fax Number:
509-335-8357
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHERMAK
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PROFESSOR AND CHAIR
Authorized Official Telephone Number:
509-335-4526

Provider Taxonomy Codes

  • Taxonomy code: 231HA2500X , with the licence number:  00003762 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 00549253 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000010156099 . This is a "SPEECHLANGUAGEHEARING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7118771 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17209 . This is a "SPEECHLANGUAGEHEARING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7259302 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805173000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010156099 . This is a "SPEECHLANGUAGEHEARING" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 224297224297 . This is a "SPEECHLANGUAGEHEARING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 75243 . This is a "SPEECHLANGUAGEHEARING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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