1811036528 NPI number — MARY L ZEHR MA, SLP

Table of content: MARY L ZEHR MA, SLP (NPI 1811036528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811036528 NPI number — MARY L ZEHR MA, SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEHR
Provider First Name:
MARY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, SLP
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:
1811036528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 DEPAUW BLVD STE 3070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46268-6135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-324-0885
Provider Business Mailing Address Fax Number:
765-450-6664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7311 EAGLE CREST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47715-8157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-213-8031
Provider Business Practice Location Address Fax Number:
765-450-6664
Provider Enumeration Date:
02/06/2007

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:  22001980A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01084014 . This is a "ASHA BOARD CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200725440A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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