1326350133 NPI number — MRS. TRINITY C DUNGAN M.S., CCC-SLP

Table of content: MRS. TRINITY C DUNGAN M.S., CCC-SLP (NPI 1326350133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326350133 NPI number — MRS. TRINITY C DUNGAN M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNGAN
Provider First Name:
TRINITY
Provider Middle Name:
C
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:
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:
1326350133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 BELLETOWER TURN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39402-7523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-410-4122
Provider Business Mailing Address Fax Number:
601-348-0836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 BELLETOWER TURN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATTIESBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39402-7523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-410-4122
Provider Business Practice Location Address Fax Number:
601-348-0836
Provider Enumeration Date:
07/08/2010

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:  S2188 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06634331 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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