1760612006 NPI number — ALLISON O'STEEN PARKER MACCCSLP

Table of content: ALLISON O'STEEN PARKER MACCCSLP (NPI 1760612006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760612006 NPI number — ALLISON O'STEEN PARKER MACCCSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
ALLISON
Provider Middle Name:
O'STEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MACCCSLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'STEEN
Provider Other First Name:
ALLISON
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760612006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4012 PARK RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28209-2377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-332-4834
Provider Business Mailing Address Fax Number:
704-372-9653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4012 PARK RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-2377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-332-4834
Provider Business Practice Location Address Fax Number:
704-372-9653
Provider Enumeration Date:
07/21/2009

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:  SLP007120 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 10978 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003108706A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com