Provider Demographics
NPI:1093400731
Name:NEURO SPEECH THERAPY
Entity Type:Organization
Organization Name:NEURO SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:541-204-1757
Mailing Address - Street 1:1372 NE WHISPER RIDGE DR APT 3
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6416
Mailing Address - Country:US
Mailing Address - Phone:541-204-1757
Mailing Address - Fax:
Practice Address - Street 1:1372 NE WHISPER RIDGE DR APT 3
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6416
Practice Address - Country:US
Practice Address - Phone:541-204-1757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty