Provider Demographics
NPI:1558979997
Name:SPEAK LIFE SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:SPEAK LIFE SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:913-396-1711
Mailing Address - Street 1:352 E CHEYENNE CT
Mailing Address - Street 2:
Mailing Address - City:KECHI
Mailing Address - State:KS
Mailing Address - Zip Code:67067-8629
Mailing Address - Country:US
Mailing Address - Phone:913-396-1711
Mailing Address - Fax:
Practice Address - Street 1:352 E CHEYENNE CT
Practice Address - Street 2:
Practice Address - City:KECHI
Practice Address - State:KS
Practice Address - Zip Code:67067-8629
Practice Address - Country:US
Practice Address - Phone:913-396-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3835OtherKANSAS STATE LICENSE