1215203096 NPI number — EILEEN MARIE KRIEG SLP

Table of content: EILEEN MARIE KRIEG SLP (NPI 1215203096)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215203096 NPI number — EILEEN MARIE KRIEG SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRIEG
Provider First Name:
EILEEN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCOTT
Provider Other First Name:
EILEEN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215203096
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 E STATE ST
Provider Second Line Business Mailing Address:
#1
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-390-6128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
489 DEVON PARK DRIVE
Provider Second Line Business Practice Location Address:
#301
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-367-7131
Provider Business Practice Location Address Fax Number:
215-879-8424
Provider Enumeration Date:
03/27/2012

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:  SL010779 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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