Provider Demographics
NPI:1093192593
Name:CONNECTED COMMUNICATION THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:CONNECTED COMMUNICATION THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-329-5888
Mailing Address - Street 1:207 34TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7975
Mailing Address - Country:US
Mailing Address - Phone:218-329-5888
Mailing Address - Fax:
Practice Address - Street 1:207 34TH AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-7975
Practice Address - Country:US
Practice Address - Phone:218-329-5888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND942261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech