1679054084 NPI number — AMY RAE KRIEGER M.S., CCC/SLP

Table of content: AMY RAE KRIEGER M.S., CCC/SLP (NPI 1679054084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679054084 NPI number — AMY RAE KRIEGER M.S., CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRIEGER
Provider First Name:
AMY
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., 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:
LUTHER
Provider Other First Name:
AMY
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC/SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679054084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 81
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19470-0081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-923-0440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 SAINT PETERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PETERS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19470-9901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-923-0440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2018

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:  SL003176L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9394634 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com