Provider Demographics
NPI:1194024588
Name:LA SPEECH THERAPY PC
Entity Type:Organization
Organization Name:LA SPEECH THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGHANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAIGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:731-599-9896
Mailing Address - Street 1:126 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-3349
Mailing Address - Country:US
Mailing Address - Phone:731-599-9896
Mailing Address - Fax:731-599-9922
Practice Address - Street 1:126 EAST MAIN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-3926
Practice Address - Country:US
Practice Address - Phone:731-599-9896
Practice Address - Fax:731-599-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2010-16555273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523565Medicaid