1376175315 NPI number — SARAH JO CHANEY SLP

Table of content: SARAH JO CHANEY SLP (NPI 1376175315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376175315 NPI number — SARAH JO CHANEY SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANEY
Provider First Name:
SARAH
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1376175315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 W BURLINGTON AVE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-469-3130
Provider Business Mailing Address Fax Number:
641-469-3131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 W BURLINGTON AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-469-3130
Provider Business Practice Location Address Fax Number:
641-469-3131
Provider Enumeration Date:
02/07/2020

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:  091485 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 091485 . This is a "IA SLP LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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