Provider Demographics
NPI:1578024535
Name:DOOR COUNTY SPEECH THERAPY
Entity Type:Organization
Organization Name:DOOR COUNTY SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC/SLP
Authorized Official - Phone:920-495-8288
Mailing Address - Street 1:314 N GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3340
Mailing Address - Country:US
Mailing Address - Phone:920-495-8288
Mailing Address - Fax:877-249-4134
Practice Address - Street 1:62 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2245
Practice Address - Country:US
Practice Address - Phone:920-495-8288
Practice Address - Fax:877-249-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty