1144841131 NPI number — MS. KIMBERLY ANN GILLIS MS, CCC-SLP

Table of content: MS. KIMBERLY ANN GILLIS MS, CCC-SLP (NPI 1144841131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144841131 NPI number — MS. KIMBERLY ANN GILLIS MS, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIS
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, 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:
1144841131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 DEER MEADOW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03258-6502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-892-4271
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 BELANGER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03275-3258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-485-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2020

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:  01106622 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: 1405 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01106622 . This is a "AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION (ASHA)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1405 . This is a "NEW HAMPSHIRE OFFICE OF LICENSED ALLIED HEALTH PROFESSIONALS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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