1407981228 NPI number — KATHERINE MARIE JACOLEV MA CFY SLP

Table of content: DR. DIDEM KOKTURK O.D. (NPI 1326173113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407981228 NPI number — KATHERINE MARIE JACOLEV MA CFY SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOLEV
Provider First Name:
KATHERINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA CFY SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERRY
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA CFY SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407981228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2122 2ND AVE N APT C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98109-2367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-286-2322
Provider Business Mailing Address Fax Number:
206-286-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2919 1ST AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98119-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-286-2322
Provider Business Practice Location Address Fax Number:
206-286-2301
Provider Enumeration Date:
02/22/2007

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

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

  • Identifier: 7014954 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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