1528308822 NPI number — MRS. JENNA FARMER COYER CCC-SLP

Table of content: MRS. JENNA FARMER COYER CCC-SLP (NPI 1528308822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528308822 NPI number — MRS. JENNA FARMER COYER CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COYER
Provider First Name:
JENNA
Provider Middle Name:
FARMER
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:
1528308822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3839 KIRKWOOD RUN NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-5705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-355-1168
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 CREEKSIDE VILLAGE DR NW
Provider Second Line Business Practice Location Address:
SUITE 604
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30144-2394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-974-2424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2013

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: 235Z00000X , with the licence number:  SLP007892 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com