Provider Demographics
NPI:1558887810
Name:SPEAK UP ONLINE SPEECH THERAPEUTICS LLC
Entity Type:Organization
Organization Name:SPEAK UP ONLINE SPEECH THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKE-VOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:906-249-1509
Mailing Address - Street 1:86 FEATHER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9427
Mailing Address - Country:US
Mailing Address - Phone:1906-249-1509
Mailing Address - Fax:
Practice Address - Street 1:86 FEATHER RIDGE RD
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9427
Practice Address - Country:US
Practice Address - Phone:1906-249-1509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty