Provider Demographics
NPI:1326299355
Name:THE COMMUNITY TREE
Entity Type:Organization
Organization Name:THE COMMUNITY TREE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:SALLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-288-9040
Mailing Address - Street 1:6402 ODANA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1123
Mailing Address - Country:US
Mailing Address - Phone:608-288-9040
Mailing Address - Fax:608-288-9042
Practice Address - Street 1:6402 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1123
Practice Address - Country:US
Practice Address - Phone:608-288-9040
Practice Address - Fax:608-288-9042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAMELEON GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2800-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty