1154188498 NPI number — LEANNE LOUISE GRAYBILL WA, CCC.CL61481090

Table of content: LEANNE LOUISE GRAYBILL WA, CCC.CL61481090 (NPI 1154188498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154188498 NPI number — LEANNE LOUISE GRAYBILL WA, CCC.CL61481090

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAYBILL
Provider First Name:
LEANNE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WA, CCC.CL61481090
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:
1154188498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
436 MCPHEE RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-5014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA BARTOLOMEU MITRE 792
Provider Second Line Business Practice Location Address:
C01
Provider Business Practice Location Address City Name:
RIO DE JANEIRO
Provider Business Practice Location Address State Name:
RIO DE JANEIRO
Provider Business Practice Location Address Postal Code:
22431
Provider Business Practice Location Address Country Code:
BR
Provider Business Practice Location Address Telephone Number:
717-805-3031
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2024

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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