1093065393 NPI number — VIRGINIA CLIPSON JOHNSON MACCC-SLP

Table of content: VIRGINIA CLIPSON JOHNSON MACCC-SLP (NPI 1093065393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093065393 NPI number — VIRGINIA CLIPSON JOHNSON MACCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
VIRGINIA
Provider Middle Name:
CLIPSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MACCC-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:
1093065393
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 COPPERFIELD PARKWAY #827
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEGE STATION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-601-6787
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 W. MARTIN LUTHER KING
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-209-3700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2012

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:  11157 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com