1275995748 NPI number — MRS. TENILLE M THOMPSON M.S. CCC-SLP

Table of content: MRS. TENILLE M THOMPSON M.S. CCC-SLP (NPI 1275995748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275995748 NPI number — MRS. TENILLE M THOMPSON M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
TENILLE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DALLAS
Provider Other First Name:
TENILLE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275995748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ERIE 2 CHAUTAUQUA CATTARAGUS BOCES
Provider Second Line Business Mailing Address:
8685 ERIE ROAD
Provider Business Mailing Address City Name:
ANGOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-549-4454
Provider Business Mailing Address Fax Number:
866-694-4979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
774 FAIRMOUNT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14701-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-338-0668
Provider Business Practice Location Address Fax Number:
866-694-4979
Provider Enumeration Date:
03/24/2016

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:  025526-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04409252 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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