1477980183 NPI number — PROF. NEINA F FERGUSON PH.D., CCC-SLP

Table of content: PROF. NEINA F FERGUSON PH.D., CCC-SLP (NPI 1477980183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477980183 NPI number — PROF. NEINA F FERGUSON PH.D., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
NEINA
Provider Middle Name:
F
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., 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:
1477980183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1290 E NINE MILE RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENSACOLA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32514-1653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-384-0132
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1290 E NINE MILE RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32514-1653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-857-9343
Provider Business Practice Location Address Fax Number:
844-848-7557
Provider Enumeration Date:
09/27/2013

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: 222Q00000X , with the licence number:  6756 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA 6756 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 019229200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103760300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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