Provider Demographics
NPI:1164940417
Name:JB SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:JB SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JACLYNN
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:808-446-6167
Mailing Address - Street 1:368 ALIIOLANI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8314
Mailing Address - Country:US
Mailing Address - Phone:808-446-6167
Mailing Address - Fax:808-579-8049
Practice Address - Street 1:368 ALIIOLANI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8314
Practice Address - Country:US
Practice Address - Phone:808-446-6167
Practice Address - Fax:808-579-8049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty