1760447130 NPI number — MS. JILLIAN NICOLE SALMONS LISW

Table of content: MS. JILLIAN NICOLE SALMONS LISW (NPI 1760447130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760447130 NPI number — MS. JILLIAN NICOLE SALMONS LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALMONS
Provider First Name:
JILLIAN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EYNON
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760447130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3086 STATE ROUTE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLIPOLIS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45631-8409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-446-5500
Provider Business Mailing Address Fax Number:
740-441-4402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 ACY AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45640-0828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-286-5075
Provider Business Practice Location Address Fax Number:
740-288-7335
Provider Enumeration Date:
04/19/2006

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: 1041C0700X , with the licence number:  I0600125 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0253701 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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