1154528347 NPI number — MRS. NANETTE ANN BLANDFORD SPEECH THERAPIST

Table of content: MRS. NANETTE ANN BLANDFORD SPEECH THERAPIST (NPI 1154528347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154528347 NPI number — MRS. NANETTE ANN BLANDFORD SPEECH THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANDFORD
Provider First Name:
NANETTE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SPEECH THERAPIST
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:
1154528347
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1668
Provider Second Line Business Mailing Address:
815 TRIPLETT ST
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42302-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-683-4517
Provider Business Mailing Address Fax Number:
270-852-1491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 TRIPLETT ST
Provider Second Line Business Practice Location Address:
WENDELL FOSTERS CAMPUS FOR DEVELOPMENTAL DISABILITIES
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-683-4517
Provider Business Practice Location Address Fax Number:
270-852-1491
Provider Enumeration Date:
06/29/2007

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:  2978 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45118379 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33000035 . This is a "MEDICAID SCL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 11903135 . This is a "MEDICAID ICF" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com