1982770103 NPI number — MR. RONALD WAYNE BENNETT LCPC

Table of content: MR. RONALD WAYNE BENNETT LCPC (NPI 1982770103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982770103 NPI number — MR. RONALD WAYNE BENNETT LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
RONALD
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
M

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:
1982770103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
809 OVERLOOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKFORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60423-1053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-351-2299
Provider Business Mailing Address Fax Number:
815-469-9202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
809 OVERLOOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60423-1053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-351-2299
Provider Business Practice Location Address Fax Number:
815-469-9202
Provider Enumeration Date:
11/28/2006

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: 101YM0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 244552 . This is a "COMPSYCH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 192753 . This is a "VALUEOPTIONS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 09932319 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com