Provider Demographics
NPI:1164588307
Name:CENTER FOR SPEECH, LANGUAGE AND LEARNING, INC.
Entity Type:Organization
Organization Name:CENTER FOR SPEECH, LANGUAGE AND LEARNING, INC.
Other - Org Name:CENTER FOR SPEECH LANGUAGE LEA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-739-2300
Mailing Address - Street 1:434 HAYWARD AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5379
Mailing Address - Country:US
Mailing Address - Phone:651-739-2300
Mailing Address - Fax:651-698-1729
Practice Address - Street 1:434 HAYWARD AVE N
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5379
Practice Address - Country:US
Practice Address - Phone:651-739-2300
Practice Address - Fax:651-739-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27212800Medicaid