1306481171 NPI number — MRS. JENNIFER RUSSELL HORNBY LPC

Table of content: MRS. JENNIFER RUSSELL HORNBY LPC (NPI 1306481171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306481171 NPI number — MRS. JENNIFER RUSSELL HORNBY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORNBY
Provider First Name:
JENNIFER
Provider Middle Name:
RUSSELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUSSELL
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306481171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3897 BRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23435-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-394-1961
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3897 BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23435-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-394-1961
Provider Business Practice Location Address Fax Number:
757-394-1965
Provider Enumeration Date:
11/15/2019

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: 101YP2500X , with the licence number:  0701008775 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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