Provider Demographics
NPI:1073724852
Name:NORTHWEST SPEECH AND LANGUAGE CENTER
Entity Type:Organization
Organization Name:NORTHWEST SPEECH AND LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:FERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MCD CCC-SLP
Authorized Official - Phone:702-449-5105
Mailing Address - Street 1:9538 MILKWEED CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-3759
Mailing Address - Country:US
Mailing Address - Phone:702-449-5105
Mailing Address - Fax:702-430-9826
Practice Address - Street 1:2851 N TENAYA WAY STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0453
Practice Address - Country:US
Practice Address - Phone:702-449-5105
Practice Address - Fax:702-430-9826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV728581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty