1497803688 NPI number — MRS. SUZANNE C. HERMAN SLP

Table of content: MRS. SUZANNE C. HERMAN SLP (NPI 1497803688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497803688 NPI number — MRS. SUZANNE C. HERMAN SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERMAN
Provider First Name:
SUZANNE
Provider Middle Name:
C.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1497803688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2117 S FLEISHEL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75701-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-581-5421
Provider Business Mailing Address Fax Number:
903-581-4515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2117 S FLEISHEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-4440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-581-5421
Provider Business Practice Location Address Fax Number:
903-581-4515
Provider Enumeration Date:
01/06/2007

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:  11594 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005616001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609080613 . This is a "NPI GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 752886218 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 87327T GROUP 0072EL . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1194961888 . This is a "NPI 2-ORGANIZATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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