1952736027 NPI number — MS. LEANN CHRISTINE CARRUTHERS SLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952736027 NPI number — MS. LEANN CHRISTINE CARRUTHERS SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARRUTHERS
Provider First Name:
LEANN
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
LEANN
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952736027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7887 DITTMER RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DITTMER
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63023-1113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-274-5327
Provider Business Mailing Address Fax Number:
636-274-0413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7887 DITTMER RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DITTMER
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63023-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-274-5327
Provider Business Practice Location Address Fax Number:
636-274-0413
Provider Enumeration Date:
09/09/2013

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:  2013028246 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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