1427098854 NPI number — AMBER SOUKUP LSCSW

Table of content: DR. TAYLOR JUSTINE RUTHERFORD DO (NPI 1598407553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427098854 NPI number — AMBER SOUKUP LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUKUP
Provider First Name:
AMBER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADY
Provider Other First Name:
AMBER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427098854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 JUPITER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-7317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-309-5060
Provider Business Mailing Address Fax Number:
785-309-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 JUPITER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401-7317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-309-5060
Provider Business Practice Location Address Fax Number:
785-309-5001
Provider Enumeration Date:
06/07/2006

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: 1041C0700X , with the licence number:  LSCSW 3604 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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