1649358573 NPI number — NANCY KRISTINE HALLER GCFP NCMMT LMP MA

Table of content: MRS. MYCHAL ELIZABETH COX MS, CCC-SLP (NPI 1447603071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649358573 NPI number — NANCY KRISTINE HALLER GCFP NCMMT LMP MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLER
Provider First Name:
NANCY
Provider Middle Name:
KRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
GCFP NCMMT LMP MA
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:
1649358573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
821 S 219TH ST APT 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98198-6364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-282-0406
Provider Business Mailing Address Fax Number:
206-824-7378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 S 219TH ST APT 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98198-6364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-282-0406
Provider Business Practice Location Address Fax Number:
206-824-7378
Provider Enumeration Date:
11/01/2006

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: 204C00000X , with the licence number:  GCFP1653 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081N0008X , with the licence number: 1653 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081N0008X , with the licence number: MA00008877 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: NCMMT0019 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA00008877 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0151472 . This is a "LABOR AND INDUSTRIES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912120516 . This is a "HMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 146525495 . This is a "PACIFICCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 533829001 . This is a "GROUP HEALTH COOPERATIVE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912120516 . This is a "AMERICAN WHOLEHEALTH NETW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341120341120 . This is a "PREMERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341120341120 . This is a "LIFEWISE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912120516 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912120516 . This is a "KPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912120516 . This is a "GUARDIAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912120516 . This is a "FIRST CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005102596 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 912120516 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91212051600 . This is a "UNIFORM" identifier . This identifiers is of the category "OTHER".
  • Identifier: HA4253 . This is a "REGENCE" identifier . This identifiers is of the category "OTHER".




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