Provider Demographics
NPI:1487186060
Name:THE SPEECH MOM LLC
Entity Type:Organization
Organization Name:THE SPEECH MOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOERIGTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA SLP CCC
Authorized Official - Phone:712-470-2520
Mailing Address - Street 1:2109 S FARIS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2442
Mailing Address - Country:US
Mailing Address - Phone:712-470-2520
Mailing Address - Fax:
Practice Address - Street 1:2109 S FARIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2442
Practice Address - Country:US
Practice Address - Phone:712-470-2520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD496-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty