1861683443 NPI number — MISS MISHAUN KATHLEEN MACLELLAN M.S. CCC SLP

Table of content: MISS MISHAUN KATHLEEN MACLELLAN M.S. CCC SLP (NPI 1861683443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861683443 NPI number — MISS MISHAUN KATHLEEN MACLELLAN M.S. CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACLELLAN
Provider First Name:
MISHAUN
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC 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:
1861683443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
895 ROBERTA LN
Provider Second Line Business Mailing Address:
101A
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89431-6802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-825-4744
Provider Business Mailing Address Fax Number:
775-351-1644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
895 ROBERTA LN
Provider Second Line Business Practice Location Address:
101A
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89431-6802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-825-4744
Provider Business Practice Location Address Fax Number:
775-351-1644
Provider Enumeration Date:
08/07/2007

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:  SP1090 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com