Provider Demographics
NPI:1225726078
Name:STELLAR MINDS SPEECH AND FEEDING THERAPY LLC
Entity Type:Organization
Organization Name:STELLAR MINDS SPEECH AND FEEDING THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:
Authorized Official - Last Name:HALVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:304-376-2908
Mailing Address - Street 1:650 ENTERPRISE BLVD APT 10202
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8555
Mailing Address - Country:US
Mailing Address - Phone:304-376-2908
Mailing Address - Fax:
Practice Address - Street 1:650 ENTERPRISE BLVD APT 10202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-8555
Practice Address - Country:US
Practice Address - Phone:304-376-2908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty