Provider Demographics
NPI:1285861369
Name:LAKESHORE SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:LAKESHORE SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:440-471-7190
Mailing Address - Street 1:815 CROCKER ROAD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-471-7190
Mailing Address - Fax:480-287-8108
Practice Address - Street 1:815 CROCKER RD
Practice Address - Street 2:SUITE #3
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-471-7190
Practice Address - Fax:480-287-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP4771235Z00000X
OHSP5229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty