1215023304 NPI number — TIMOTHY MCINTOSH DAY M.S.W., L.I.C.S.W.

Table of content: (NPI 1780661751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215023304 NPI number — TIMOTHY MCINTOSH DAY M.S.W., L.I.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAY
Provider First Name:
TIMOTHY
Provider Middle Name:
MCINTOSH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.W., L.I.C.S.W.
Provider Gender Code:
M

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:
1215023304
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:
2736 LYNDALE AVE S
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55408-1309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-817-1700
Provider Business Mailing Address Fax Number:
763-389-8511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6173 COUNTY ROAD 6 NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55371-5315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-817-1700
Provider Business Practice Location Address Fax Number:
763-389-8511
Provider Enumeration Date:
10/05/2006

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: 1041C0700X , with the licence number:  11861 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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