1396453411 NPI number — SUSAN LEJANE GELLINGER MS, CCC

Table of content: SUSAN LEJANE GELLINGER MS, CCC (NPI 1396453411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396453411 NPI number — SUSAN LEJANE GELLINGER MS, CCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GELLINGER
Provider First Name:
SUSAN
Provider Middle Name:
LEJANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, CCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELCH
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LEJANE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396453411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITESBORO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-815-8855
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W. PEACAN
Provider Second Line Business Practice Location Address:
GRAYSON CO. SPECIAL EDUCATION COOP
Provider Business Practice Location Address City Name:
GUNTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-696-0015
Provider Business Practice Location Address Fax Number:
903-696-0019
Provider Enumeration Date:
11/08/2022

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:  11405 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 00069864 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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