Provider Demographics
NPI:1174679534
Name:PEDIATRIC SPEECH SOLUTIONS INCORPORATED
Entity Type:Organization
Organization Name:PEDIATRIC SPEECH SOLUTIONS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:ELIZABETH ANN
Authorized Official - Last Name:VENAAS GILBRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-238-3908
Mailing Address - Street 1:10318 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8116
Mailing Address - Country:US
Mailing Address - Phone:701-238-3908
Mailing Address - Fax:701-232-2330
Practice Address - Street 1:10318 6TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8116
Practice Address - Country:US
Practice Address - Phone:701-238-3908
Practice Address - Fax:701-232-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55035Medicaid
ND25292Medicare UPIN
ND55035Medicaid