Provider Demographics
NPI:1073292967
Name:CU SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:CU SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIEBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-377-9191
Mailing Address - Street 1:105 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-5032
Mailing Address - Country:US
Mailing Address - Phone:217-282-0248
Mailing Address - Fax:
Practice Address - Street 1:201 W SPRINGFIELD AVE STE 702
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4845
Practice Address - Country:US
Practice Address - Phone:217-282-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech