Provider Demographics
NPI:1275206492
Name:MLS ENTERPRISES LLC
Entity Type:Organization
Organization Name:MLS ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZO-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:408-905-6127
Mailing Address - Street 1:7042 AZURE BEACH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2856
Mailing Address - Country:US
Mailing Address - Phone:408-905-6127
Mailing Address - Fax:
Practice Address - Street 1:7042 AZURE BEACH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2856
Practice Address - Country:US
Practice Address - Phone:408-905-6127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty