1437203221 NPI number — MRS. DEBORAH M. VANCE CCC,SLP

Table of content: MRS. DEBORAH M. VANCE CCC,SLP (NPI 1437203221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437203221 NPI number — MRS. DEBORAH M. VANCE CCC,SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANCE
Provider First Name:
DEBORAH
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CCC,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:
1437203221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2109 ROSEMONT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLFAX
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27235-9638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-688-2591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3816 N ELM ST STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27455-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-370-4070
Provider Business Practice Location Address Fax Number:
336-370-9008
Provider Enumeration Date:
01/22/2007

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 , with the licence number:  406 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 137KF . This is a "BCBS INDIV.PROVIDER#" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 013X1 . This is a "BCBS GROUP PROV. #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7411224 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7211258 . This is a "MEDICAID GROUP PROV. #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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