Provider Demographics
NPI:1144391475
Name:ENTERPRISE SPEECH AND LEARNING CENTER, LLC
Entity Type:Organization
Organization Name:ENTERPRISE SPEECH AND LEARNING CENTER, LLC
Other - Org Name:ENTERPRISE SPEECH AND LEARNING CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-393-7500
Mailing Address - Street 1:PO BOX 310178
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36331-0178
Mailing Address - Country:US
Mailing Address - Phone:334-393-7500
Mailing Address - Fax:334-393-7505
Practice Address - Street 1:1018 RUCKER BLVD STE D
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-3688
Practice Address - Country:US
Practice Address - Phone:334-393-5555
Practice Address - Fax:334-308-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12983261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521673OtherBCBS
AL51521673OtherBCBS
AL=========OtherTRICARE
AL=========OtherTRICARE