Provider Demographics
NPI:1407925704
Name:WEST ALABAMA SPEECH PATHOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:WEST ALABAMA SPEECH PATHOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:SLOUGH
Authorized Official - Last Name:HASS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:205-345-5488
Mailing Address - Street 1:507 ENERGY CENTER BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473
Mailing Address - Country:US
Mailing Address - Phone:205-345-5488
Mailing Address - Fax:205-345-8819
Practice Address - Street 1:507 ENERGY CENTER BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473
Practice Address - Country:US
Practice Address - Phone:205-345-5488
Practice Address - Fax:205-345-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL745235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51537068OtherBLUE CROSS BLUE SHIELD