Provider Demographics
NPI:1568837375
Name:K E GREEN SPEECH AND LANGUAGE LLC
Entity Type:Organization
Organization Name:K E GREEN SPEECH AND LANGUAGE LLC
Other - Org Name:GREEN LIVING & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:614-974-2211
Mailing Address - Street 1:3600 OLENTANGY RIVER RD
Mailing Address - Street 2:BLDG D, STE 107
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3437
Mailing Address - Country:US
Mailing Address - Phone:614-974-2211
Mailing Address - Fax:614-974-2215
Practice Address - Street 1:3600 OLENTANGY RIVER RD
Practice Address - Street 2:BLDG D, STE 107
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3437
Practice Address - Country:US
Practice Address - Phone:614-974-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP9217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty