Provider Demographics
NPI:1497403703
Name:SPEECH & MYOFUNCTIONAL THERAPY OF DES MOINES
Entity Type:Organization
Organization Name:SPEECH & MYOFUNCTIONAL THERAPY OF DES MOINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSK
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:515-493-9347
Mailing Address - Street 1:1501 42ND ST STE 470
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 42ND ST STE 470
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1090
Practice Address - Country:US
Practice Address - Phone:515-493-9347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty