1366706566 NPI number — SPEECH AND SWALLOWING REHABILITATION, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366706566 NPI number — SPEECH AND SWALLOWING REHABILITATION, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH AND SWALLOWING REHABILITATION, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1366706566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 HARBOR GLEN DR SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35756-2812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-684-2114
Provider Business Mailing Address Fax Number:
256-464-9243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7027 OLD MADISON PIKE NW
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35806-2368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-684-2124
Provider Business Practice Location Address Fax Number:
256-464-9243
Provider Enumeration Date:
07/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DELAINE
Authorized Official First Name:
SHERMETRA
Authorized Official Middle Name:
RENA
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
256-684-2124

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2235 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com