1184751653 NPI number — MRS. JENNIFER DIANE ENOTE BECKER M.S.CCC-SLP

Table of content: MRS. JENNIFER DIANE ENOTE BECKER M.S.CCC-SLP (NPI 1184751653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184751653 NPI number — MRS. JENNIFER DIANE ENOTE BECKER M.S.CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENOTE BECKER
Provider First Name:
JENNIFER
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.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:
1184751653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1691
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZUNI
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87327-1691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-782-4294
Provider Business Mailing Address Fax Number:
505-782-5879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 SALT LAKE ROAD
Provider Second Line Business Practice Location Address:
DOWA YALANNE ELEMENTARY
Provider Business Practice Location Address City Name:
ZUNI
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-782-4441
Provider Business Practice Location Address Fax Number:
505-782-5879
Provider Enumeration Date:
02/28/2007

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:  000G6294 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000G6294 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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