Provider Demographics
NPI:1013414523
Name:COLUMBIA PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:COLUMBIA PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-819-5399
Mailing Address - Street 1:3551 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3432
Mailing Address - Country:US
Mailing Address - Phone:573-819-5399
Mailing Address - Fax:
Practice Address - Street 1:1818 W WORLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1038
Practice Address - Country:US
Practice Address - Phone:573-214-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12495034Medicaid
MO=========1Medicaid