1831214485 NPI number — MISS CHASIDY COLLEEN SUMMER FOGG M.A. LLP LPC

Table of content: MISS CHASIDY COLLEEN SUMMER FOGG M.A. LLP LPC (NPI 1831214485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831214485 NPI number — MISS CHASIDY COLLEEN SUMMER FOGG M.A. LLP LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOGG
Provider First Name:
CHASIDY
Provider Middle Name:
COLLEEN SUMMER
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.A. LLP LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
CHASIDY
Provider Other Middle Name:
COLLEEN SUMMER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA LLP LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831214485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4287 RACE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LESLIE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49251-9446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-712-7204
Provider Business Mailing Address Fax Number:
517-796-4561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4287 RACE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LESLIE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49251-9446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-712-7204
Provider Business Practice Location Address Fax Number:
517-796-4561
Provider Enumeration Date:
03/20/2007

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: 101YP2500X , with the licence number:  6401010112 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: 6301013308 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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