1104835263 NPI number — MS. SUSAN LYNNE EICHMAN-PARCELL M.A.

Table of content: MS. SUSAN LYNNE EICHMAN-PARCELL M.A. (NPI 1104835263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104835263 NPI number — MS. SUSAN LYNNE EICHMAN-PARCELL M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EICHMAN-PARCELL
Provider First Name:
SUSAN
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
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:
1104835263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 W. NORTHSHORE AVENUE
Provider Second Line Business Mailing Address:
2N
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60626-5636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-259-9574
Provider Business Mailing Address Fax Number:
773-296-3226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 W NORTH SHORE AVE
Provider Second Line Business Practice Location Address:
2N
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60626-4766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-259-9574
Provider Business Practice Location Address Fax Number:
773-296-3226
Provider Enumeration Date:
08/07/2006

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: 101YP2500X , with the licence number:  180-003179 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 326165 . This is a "MANAGED HEALTHCARENETWORK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 493819000 . This is a "MAGELLANBEHAVIORALHEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 741469000 . This is a "MAGELLANBEHAVIORALHEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 276614 . This is a "MANAGED HEALTHCARENETWORK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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