1700801008 NPI number — JACQUELINE MARIE HOOVER MS, LCGC

Table of content: JACQUELINE MARIE HOOVER MS, LCGC (NPI 1700801008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700801008 NPI number — JACQUELINE MARIE HOOVER MS, LCGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOVER
Provider First Name:
JACQUELINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LCGC
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:
1700801008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12311 PERRY HIGHWAY
Provider Second Line Business Mailing Address:
WEXFORD HEALTH AND WELLNESS PAVILLION, 2ND FLOOR
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
878-332-4401
Provider Business Mailing Address Fax Number:
878-332-4496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12311 PERRY HIGHWAY
Provider Second Line Business Practice Location Address:
WEXFORD HEALTH AND WELLNESS PAVILLION, 2ND FLOOR
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-692-5935
Provider Business Practice Location Address Fax Number:
412-692-6472
Provider Enumeration Date:
07/13/2006

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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