1689940538 NPI number — LISA DIANE HODGE MT-BC

Table of content: LISA DIANE HODGE MT-BC (NPI 1689940538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689940538 NPI number — LISA DIANE HODGE MT-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODGE
Provider First Name:
LISA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MT-BC
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:
1689940538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85281-0021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-965-1082
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E CURRY ROAD
Provider Second Line Business Practice Location Address:
ROOM 307C
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85281-0021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-965-1082
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2012

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: 225A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10182 . This is a "CERTIFICATION BOARD FOR MUSIC THERAPISTS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com