Provider Demographics
NPI:1225391626
Name:ADVANCED PEDIATRIC SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:ADVANCED PEDIATRIC SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARTINEZ
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:509-521-3644
Mailing Address - Street 1:4206 W 24TH AVE STE B104
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2321
Mailing Address - Country:US
Mailing Address - Phone:509-521-3644
Mailing Address - Fax:
Practice Address - Street 1:4206 W 24TH AVE STE B104
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2321
Practice Address - Country:US
Practice Address - Phone:509-521-3644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty