Provider Demographics
NPI:1417438417
Name:KAHL THERAPY CORNER, LLC
Entity Type:Organization
Organization Name:KAHL THERAPY CORNER, LLC
Other - Org Name:KAHL THERAPY CORNER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/SPEECH LANGAUGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:712-310-8395
Mailing Address - Street 1:1415 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3922
Mailing Address - Country:US
Mailing Address - Phone:712-308-8233
Mailing Address - Fax:888-975-0225
Practice Address - Street 1:1500 N 16TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-0150
Practice Address - Country:US
Practice Address - Phone:712-310-8395
Practice Address - Fax:888-975-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1124495692Medicaid
IA1124495692Medicaid