Provider Demographics
NPI:1265032502
Name:KIWI SPEECH, LLC
Entity Type:Organization
Organization Name:KIWI SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-921-6192
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-0141
Mailing Address - Country:US
Mailing Address - Phone:248-921-6192
Mailing Address - Fax:
Practice Address - Street 1:137 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1814
Practice Address - Country:US
Practice Address - Phone:248-921-6192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty