Provider Demographics
NPI:1568693117
Name:ALASKAS SPEECH & LANGUAGE CLINIC, INC.
Entity Type:Organization
Organization Name:ALASKAS SPEECH & LANGUAGE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:907-283-4300
Mailing Address - Street 1:PO BOX 3187
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-3187
Mailing Address - Country:US
Mailing Address - Phone:907-283-4300
Mailing Address - Fax:907-283-4362
Practice Address - Street 1:110 TRADING BAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7716
Practice Address - Country:US
Practice Address - Phone:907-283-4300
Practice Address - Fax:907-283-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty