1366678765 NPI number — MRS. PATRICIA MARY JAGLOWSKI MS SPEECH PATHOLOGY

Table of content: MRS. PATRICIA MARY JAGLOWSKI MS SPEECH PATHOLOGY (NPI 1366678765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366678765 NPI number — MRS. PATRICIA MARY JAGLOWSKI MS SPEECH PATHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAGLOWSKI
Provider First Name:
PATRICIA
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS SPEECH PATHOLOGY
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:
1366678765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N6281 HILLCREST TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGTON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53105-2832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-902-1422
Provider Business Mailing Address Fax Number:
262-763-3006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N6281 HILLCREST TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53105-2832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-902-1422
Provider Business Practice Location Address Fax Number:
262-763-3006
Provider Enumeration Date:
05/31/2009

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: 235Z00000X , with the licence number:  J242 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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