Provider Demographics
NPI:1225495054
Name:SPEECH PATHOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-756-6100
Mailing Address - Street 1:5521 W LINCOLN HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-1097
Mailing Address - Country:US
Mailing Address - Phone:219-756-6100
Mailing Address - Fax:219-756-6111
Practice Address - Street 1:5521 W LINCOLN HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1097
Practice Address - Country:US
Practice Address - Phone:219-756-6100
Practice Address - Fax:219-756-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003634A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty