1295279412 NPI number — MRS. BARBARA LESLIE SLEMMONS MSW

Table of content: MRS. BARBARA LESLIE SLEMMONS MSW (NPI 1295279412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295279412 NPI number — MRS. BARBARA LESLIE SLEMMONS MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLEMMONS
Provider First Name:
BARBARA
Provider Middle Name:
LESLIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COOK
Provider Other First Name:
BARBARA
Provider Other Middle Name:
LESLIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295279412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
234 CARLOW WAY
Provider Second Line Business Mailing Address:
UNIT 103
Provider Business Mailing Address City Name:
HARDEEVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29927
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-291-0423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 TRADERS CROSS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKATIE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-291-0423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2016

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: 1041C0700X , with the licence number:  149.017456 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SW1419 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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