Provider Demographics
NPI:1396033635
Name:BEMIDJI SPEECH-LANGUAGE SERVICES INC
Entity Type:Organization
Organization Name:BEMIDJI SPEECH-LANGUAGE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:218-368-6440
Mailing Address - Street 1:522 BELTRAMI AVE NW
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3001
Mailing Address - Country:US
Mailing Address - Phone:218-368-6440
Mailing Address - Fax:218-444-8367
Practice Address - Street 1:522 BELTRAMI AVE NW
Practice Address - Street 2:SUITE 107
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3001
Practice Address - Country:US
Practice Address - Phone:218-368-6440
Practice Address - Fax:218-444-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty