1518993088 NPI number — MRS. JENNIFER SPINNEWEBER DOEHLA LPCC

Table of content: MRS. JENNIFER SPINNEWEBER DOEHLA LPCC (NPI 1518993088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518993088 NPI number — MRS. JENNIFER SPINNEWEBER DOEHLA LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOEHLA
Provider First Name:
JENNIFER
Provider Middle Name:
SPINNEWEBER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPINNEWEBER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518993088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 PARK AVE W
Provider Second Line Business Mailing Address:
SUITE # 706
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44902-1648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-772-4725
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 PARK AVE W
Provider Second Line Business Practice Location Address:
SUITE # 706
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44902-1648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-772-4725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2006

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: 101YP2500X , with the licence number:  E1300084 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 5184 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1518993088 . This is a "NATIONAL PROVIDER IDENTIFICATION NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1412C . This is a "BLUE CROSS BLUE SHIELDS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6103150 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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