Provider Demographics
NPI:1235765918
Name:CONNECT SPEECH & LANGUAGE, LLC
Entity Type:Organization
Organization Name:CONNECT SPEECH & LANGUAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:907-887-6181
Mailing Address - Street 1:P.O. BOX 110145
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0145
Mailing Address - Country:US
Mailing Address - Phone:907-887-6181
Mailing Address - Fax:844-975-1181
Practice Address - Street 1:1803 KEPNER DR.
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3061
Practice Address - Country:US
Practice Address - Phone:907-887-6181
Practice Address - Fax:844-975-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1707800Medicaid