1710265202 NPI number — IRINA KRIVORUCHKO M.S., SLP-CFY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710265202 NPI number — IRINA KRIVORUCHKO M.S., SLP-CFY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRIVORUCHKO
Provider First Name:
IRINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., SLP-CFY
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:
1710265202
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7840 GOLDEN RING WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTELOPE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95843-6123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-247-7818
Provider Business Mailing Address Fax Number:
916-728-2695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2119 E NATIONAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47501-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-254-3301
Provider Business Practice Location Address Fax Number:
812-257-0039
Provider Enumeration Date:
08/01/2011

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: 235Z00000X , with the licence number:  C-4891 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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