1508482621 NPI number — ANA COLLAZO, LSCSW, LLC

Table of content: (NPI 1508482621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508482621 NPI number — ANA COLLAZO, LSCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANA COLLAZO, LSCSW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1508482621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 SW 34TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66614-4557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-608-3184
Provider Business Mailing Address Fax Number:
785-271-9003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 SW 12TH ST STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66612-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-235-6500
Provider Business Practice Location Address Fax Number:
785-271-9003
Provider Enumeration Date:
06/24/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
DEB
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
785-925-9088

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1851733844 . This is a "NPPES" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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