Provider Demographics
NPI:1508859570
Name:LEPMIZ SPEECH-LANGUAGE PATHOLOGY, LLC
Entity Type:Organization
Organization Name:LEPMIZ SPEECH-LANGUAGE PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:STUEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC
Authorized Official - Phone:218-838-4271
Mailing Address - Street 1:200 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3268
Mailing Address - Country:US
Mailing Address - Phone:218-824-7030
Mailing Address - Fax:218-824-7030
Practice Address - Street 1:200 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3268
Practice Address - Country:US
Practice Address - Phone:218-824-7030
Practice Address - Fax:218-824-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN874S2LEOtherBCBS OF MN