1902545460 NPI number — MISS ANNA RUTH WATERS MS CF SLP

Table of content: (NPI 1649437864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902545460 NPI number — MISS ANNA RUTH WATERS MS CF SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATERS
Provider First Name:
ANNA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MS CF 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:
1902545460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4804 PLEASANT LAWN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40515-1268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-473-1655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3280 BLAZER PKWY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40509-2796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-225-5424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/02/2022

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:  277639 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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