1417940180 NPI number — MS. JACQUELINE L GOWER M.ED., LPC

Table of content: MS. JACQUELINE L GOWER M.ED., LPC (NPI 1417940180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417940180 NPI number — MS. JACQUELINE L GOWER M.ED., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOWER
Provider First Name:
JACQUELINE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC
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:
1417940180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 E ELIZABETH AVE
Provider Second Line Business Mailing Address:
SUITE 412
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18018-6518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-866-6855
Provider Business Mailing Address Fax Number:
610-866-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 E ELIZABETH AVE
Provider Second Line Business Practice Location Address:
SUITE 412
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18018-6518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-866-6855
Provider Business Practice Location Address Fax Number:
610-866-6715
Provider Enumeration Date:
08/26/2005

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: 101YP2500X , with the licence number:  PC003559 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PC003559 . This is a "LICENSED PROF. COUNSELOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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