1932461076 NPI number — MS. EMILY GAVIN RASTATTER MACCC-SLP/L

Table of content: MS. EMILY GAVIN RASTATTER MACCC-SLP/L (NPI 1932461076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932461076 NPI number — MS. EMILY GAVIN RASTATTER MACCC-SLP/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASTATTER
Provider First Name:
EMILY
Provider Middle Name:
GAVIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MACCC-SLP/L
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:
1932461076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 DARLINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER FALLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15010-1305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-846-8255
Provider Business Mailing Address Fax Number:
724-647-1232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20397 ROUTE 19
Provider Second Line Business Practice Location Address:
SUITE 30
Provider Business Practice Location Address City Name:
CRANBERRY TWP.
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-6102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-877-7332
Provider Business Practice Location Address Fax Number:
866-343-1410
Provider Enumeration Date:
06/14/2012

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:  5077 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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