1831473164 NPI number — CHERYL LYNN MCNEELEY SPEECH LANGUAGE PATH

Table of content: CHERYL LYNN MCNEELEY SPEECH LANGUAGE PATH (NPI 1831473164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831473164 NPI number — CHERYL LYNN MCNEELEY SPEECH LANGUAGE PATH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNEELEY
Provider First Name:
CHERYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SPEECH LANGUAGE PATH
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:
1831473164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1205 F. AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLAS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-364-1429
Provider Business Mailing Address Fax Number:
520-364-4261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 E. 15TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLAS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-364-1429
Provider Business Practice Location Address Fax Number:
520-364-4261
Provider Enumeration Date:
10/05/2011

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

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





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