Provider Demographics
NPI:1558510404
Name:SPEECH TIME LLC.
Entity Type:Organization
Organization Name:SPEECH TIME LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-682-9011
Mailing Address - Street 1:998 BARTON AVE NW
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-4401
Mailing Address - Country:US
Mailing Address - Phone:763-682-9011
Mailing Address - Fax:763-682-9011
Practice Address - Street 1:998 BARTON AVE NW
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-4401
Practice Address - Country:US
Practice Address - Phone:763-682-9011
Practice Address - Fax:763-682-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty