1649551961 NPI number — MRS. JESSICA B WHALEN AUD, CCC-A

Table of content: MRS. JESSICA B WHALEN AUD, CCC-A (NPI 1649551961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649551961 NPI number — MRS. JESSICA B WHALEN AUD, CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHALEN
Provider First Name:
JESSICA
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AUD, CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIRK
Provider Other First Name:
JESSICA
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD, CCC-A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649551961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 SW LANE ST
Provider Second Line Business Mailing Address:
STE #200
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66606-1543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-233-0500
Provider Business Mailing Address Fax Number:
785-233-0660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 SW LANE ST
Provider Second Line Business Practice Location Address:
STE #200
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606-1543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-233-0500
Provider Business Practice Location Address Fax Number:
785-233-0660
Provider Enumeration Date:
08/31/2011

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: 231H00000X , with the licence number:  2201 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200749300B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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