Provider Demographics
NPI:1558785451
Name:KALAMAZOO SPEECH ASSOCIATES, INC.
Entity Type:Organization
Organization Name:KALAMAZOO SPEECH ASSOCIATES, INC.
Other - Org Name:KALAMAZOO SPEECH ASSOCIATES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER/SPEECH-LANGUAGE PATHOLOGIS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SHEPHARD
Authorized Official - Last Name:CROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:269-343-7811
Mailing Address - Street 1:1011 W MAPLE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-5803
Mailing Address - Country:US
Mailing Address - Phone:269-343-7811
Mailing Address - Fax:269-343-2810
Practice Address - Street 1:1011 W MAPLE ST STE 300
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5803
Practice Address - Country:US
Practice Address - Phone:269-343-7811
Practice Address - Fax:269-343-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MI7101000917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty