1184839177 NPI number — LAURA JILL ESKEW SLPL, SLP-A

Table of content: LAURA JILL ESKEW SLPL, SLP-A (NPI 1184839177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184839177 NPI number — LAURA JILL ESKEW SLPL, SLP-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESKEW
Provider First Name:
LAURA
Provider Middle Name:
JILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLPL, SLP-A
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:
1184839177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20165 N 67TH AVE STE 122A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-7155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-573-5842
Provider Business Mailing Address Fax Number:
623-321-1177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7835 N 49TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85301-8010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-793-9115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007

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: 2355S0801X , with the licence number:  SLPL4791 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2355S0801X , with the licence number: SLPA8078 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890807 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com