1295063964 NPI number — ELIZABETH REDDING SLP

Table of content: ELIZABETH REDDING SLP (NPI 1295063964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295063964 NPI number — ELIZABETH REDDING SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDING
Provider First Name:
ELIZABETH
Provider Middle Name:
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:
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:
1295063964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 STUBBS AVE
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-388-8414
Provider Business Mailing Address Fax Number:
318-388-8558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 STUBBS AVE
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-388-8414
Provider Business Practice Location Address Fax Number:
318-388-8558
Provider Enumeration Date:
11/18/2009

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: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OTA200143 . This is a "LOUISIANA STATE BOARD OF MEDICAL EXAMINERS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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