1245660752 NPI number — MS. ELLAREE LOUISE SIMPSON LISW-S,LICOC, MSSA

Table of content: MS. ELLAREE LOUISE SIMPSON LISW-S,LICOC, MSSA (NPI 1245660752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245660752 NPI number — MS. ELLAREE LOUISE SIMPSON LISW-S,LICOC, MSSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMPSON
Provider First Name:
ELLAREE
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW-S,LICOC, MSSA
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:
1245660752
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7654 SLATE RIDGE BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REYNOLDSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-626-2696
Provider Business Mailing Address Fax Number:
866-820-4098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7654 SLATE RIDGE BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REYNOLDSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-523-6629
Provider Business Practice Location Address Fax Number:
866-820-4098
Provider Enumeration Date:
11/19/2013

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: 101YA0400X , with the licence number:  956835 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: I.1201237-SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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