1740430404 NPI number — NNEKA CAMARA THOMPSON DEVELOPMENTAL THERAP

Table of content: NNEKA CAMARA THOMPSON DEVELOPMENTAL THERAP (NPI 1740430404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740430404 NPI number — NNEKA CAMARA THOMPSON DEVELOPMENTAL THERAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
NNEKA
Provider Middle Name:
CAMARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DEVELOPMENTAL THERAP
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:
1740430404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7223 SOUTH EUCLID AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-667-5060
Provider Business Mailing Address Fax Number:
312-842-2600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7223 SOUTH EUCLID AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-667-5060
Provider Business Practice Location Address Fax Number:
312-842-2600
Provider Enumeration Date:
09/30/2008

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: 174400000X , with the licence number:  NT60981002P , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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