Provider Demographics
NPI:1124199419
Name:LABORATORY OF SPEECH AND LANGUAGE DISORDERS, INC.
Entity Type:Organization
Organization Name:LABORATORY OF SPEECH AND LANGUAGE DISORDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST , OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:402-551-7338
Mailing Address - Street 1:4239 FARNAM ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2868
Mailing Address - Country:US
Mailing Address - Phone:402-551-7338
Mailing Address - Fax:402-551-3072
Practice Address - Street 1:4239 FARNAM ST
Practice Address - Street 2:SUITE 509
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2868
Practice Address - Country:US
Practice Address - Phone:402-551-7338
Practice Address - Fax:402-551-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08782OtherBCBS