1225696099 NPI number — KIRSTEN HOLMBERG TROESCHER MS, SLP

Table of content: KIRSTEN HOLMBERG TROESCHER MS, SLP (NPI 1225696099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225696099 NPI number — KIRSTEN HOLMBERG TROESCHER MS, SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROESCHER
Provider First Name:
KIRSTEN
Provider Middle Name:
HOLMBERG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLMBERG
Provider Other First Name:
KIRSTEN
Provider Other Middle Name:
EILEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225696099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4526 MACKINAC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28269-8778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-239-1370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6245 STATE ROAD 54
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34653-6006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-376-1111
Provider Business Practice Location Address Fax Number:
727-376-1113
Provider Enumeration Date:
06/05/2019

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:  SZ9044 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 14396 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14396 . This is a "NC BOARD OF SPEECH LANGUAGE PATHOLOGY & AUDIOLOGY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: SZ9044 . This is a "ST OF FL DEPT OF HEALTH BD OF SPEECH PATHOLOGY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SA17907 . This is a "ST OF FL DEPT OF HEALTH BD OF SPEECH PATHOLOGY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 103175600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com