Provider Demographics
NPI:1013201086
Name:PEDIATRIC SPEECH THERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC SPEECH THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:406-370-7342
Mailing Address - Street 1:4001 MELROSE PL
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5890
Mailing Address - Country:US
Mailing Address - Phone:406-370-7342
Mailing Address - Fax:406-552-0150
Practice Address - Street 1:4001 MELROSE PL
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5890
Practice Address - Country:US
Practice Address - Phone:406-370-7342
Practice Address - Fax:406-552-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSP 1075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty