Provider Demographics
NPI:1508007857
Name:CRISLIP SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:CRISLIP SPEECH THERAPY, LLC
Other - Org Name:CRISLIP SPEECH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:CRISLIP
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:314-479-0306
Mailing Address - Street 1:710 ABBOTTSFORD CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2553
Mailing Address - Country:US
Mailing Address - Phone:314-479-0306
Mailing Address - Fax:
Practice Address - Street 1:710 ABBOTTSFORD CT
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2553
Practice Address - Country:US
Practice Address - Phone:314-479-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004010998235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty