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1194342030 NPI number — CARLY HINTON BANNER MA, CCC-SLP

NPI Number: 1194342030
Health Care Provider/Practitioner: CARLY HINTON BANNER MA, CCC-SLP

Information about “1194342030” NPI (CARLY HINTON BANNER MA, CCC-SLP) exists in 1194342030 in HTML format HTML  |  1194342030 in plain Text format TXT  |  1194342030 in PDF (Portable Document Format) PDF  |  1194342030 in an XML format XML  formats.

NPI Number : 1194342030 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194342030",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BANNER",
    "FirstName": "CARLY",
    "MiddleName": "HINTON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA, CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HINTON",
    "OtherFirstName": "CARLY",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 912",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WELLINGTON",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80549-0912",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "719-480-2932",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4126 HAYES AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WELLINGTON",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80549",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-480-2932",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/26/2020",
    "LastUpdateDate": "02/24/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "SP-1030",
        "LicenseNumberStateCode": "WY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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