Provider Demographics
NPI:1093069908
Name:KELMIRA LATHAMS READYSETGO SPEECHINC
Entity Type:Organization
Organization Name:KELMIRA LATHAMS READYSETGO SPEECHINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:252-717-6769
Mailing Address - Street 1:3906 SOUTHAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7671
Mailing Address - Country:US
Mailing Address - Phone:252-717-6769
Mailing Address - Fax:252-756-4616
Practice Address - Street 1:3906 SOUTHAMPTON CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7671
Practice Address - Country:US
Practice Address - Phone:252-717-6769
Practice Address - Fax:252-756-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty