1134457567 NPI number — MRS. JILLIAN CHRISTINA LEVOS CARLSON B.S., SLPA

Table of content: MRS. JILLIAN CHRISTINA LEVOS CARLSON B.S., SLPA (NPI 1134457567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134457567 NPI number — MRS. JILLIAN CHRISTINA LEVOS CARLSON B.S., SLPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVOS CARLSON
Provider First Name:
JILLIAN
Provider Middle Name:
CHRISTINA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
B.S., SLPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEVOS
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
CHRISTINA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
B.S., SLPA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134457567
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25102 JEFFERSON AVE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-1707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-461-1190
Provider Business Mailing Address Fax Number:
951-461-7975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25102 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
MURRIETA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92562-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-461-1190
Provider Business Practice Location Address Fax Number:
951-461-7975
Provider Enumeration Date:
11/23/2009

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: 2355S0801X , with the licence number:  SLP-A 827 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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