Provider Demographics
NPI:1194839886
Name:L.A.S. THERAPY NETWORK SPEECH REHABILITATION & EDUCATION CONSULTATION
Entity Type:Organization
Organization Name:L.A.S. THERAPY NETWORK SPEECH REHABILITATION & EDUCATION CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MED,CCC/L-SLP
Authorized Official - Phone:615-226-1265
Mailing Address - Street 1:611 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5812
Mailing Address - Country:US
Mailing Address - Phone:615-226-1265
Mailing Address - Fax:877-235-2914
Practice Address - Street 1:611 N 5TH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-5812
Practice Address - Country:US
Practice Address - Phone:615-226-1265
Practice Address - Fax:877-235-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPSS0000000252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446680Medicaid
TN0446680Medicaid