1366630386 NPI number — MRS. JOY ANDREA MURDOCK KEARNS M.S.,CCC-SLP,LSLS,CE

Table of content: MRS. JOY ANDREA MURDOCK KEARNS M.S.,CCC-SLP,LSLS,CE (NPI 1366630386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366630386 NPI number — MRS. JOY ANDREA MURDOCK KEARNS M.S.,CCC-SLP,LSLS,CE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEARNS
Provider First Name:
JOY
Provider Middle Name:
ANDREA MURDOCK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.,CCC-SLP,LSLS,CE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURDOCK
Provider Other First Name:
JOY
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366630386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3518 JEFFERSON AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDWOOD CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-365-7500
Provider Business Mailing Address Fax Number:
650-365-7557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3518 JEFFERSON AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-365-7500
Provider Business Practice Location Address Fax Number:
650-365-7557
Provider Enumeration Date:
10/04/2007

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:  11695 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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