1154159143 NPI number — JAMIE PEYTON MAHAN MA, CF-SLP

Table of content: JAMIE PEYTON MAHAN MA, CF-SLP (NPI 1154159143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154159143 NPI number — JAMIE PEYTON MAHAN MA, CF-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHAN
Provider First Name:
JAMIE
Provider Middle Name:
PEYTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, CF-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:
1154159143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 VESTAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46168-1276
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
567-698-1003
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-844-4211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2024

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:  46004513A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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