Provider Demographics
NPI:1235216946
Name:READING AND SPEECH CLINIC, INC.
Entity Type:Organization
Organization Name:READING AND SPEECH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/DIRECTO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:541-389-3302
Mailing Address - Street 1:243 SW SCALEHOUSE LOOP
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1558
Mailing Address - Country:US
Mailing Address - Phone:541-389-3302
Mailing Address - Fax:
Practice Address - Street 1:243 SW SCALEHOUSE LOOP
Practice Address - Street 2:SUITE 2B
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1558
Practice Address - Country:US
Practice Address - Phone:541-389-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12232261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028453Medicaid