Provider Demographics
NPI:1215549902
Name:LAKES SPEECH & LANGUAGE PATHOLOGY, LLC
Entity Type:Organization
Organization Name:LAKES SPEECH & LANGUAGE PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDIE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:248-860-1555
Mailing Address - Street 1:8896 COMMERCE RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4494
Mailing Address - Country:US
Mailing Address - Phone:248-860-1555
Mailing Address - Fax:248-716-9214
Practice Address - Street 1:8896 COMMERCE RD STE 2B
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-4494
Practice Address - Country:US
Practice Address - Phone:248-860-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty