Provider Demographics
NPI:1356648125
Name:SILVER LAKE SPEECH THERAPY, LLC.
Entity Type:Organization
Organization Name:SILVER LAKE SPEECH THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:603-662-9611
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:NH
Mailing Address - Zip Code:03875-0045
Mailing Address - Country:US
Mailing Address - Phone:603-662-9611
Mailing Address - Fax:
Practice Address - Street 1:317 WALNUT LOOP
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:NH
Practice Address - Zip Code:03875-6112
Practice Address - Country:US
Practice Address - Phone:603-662-9611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty