Provider Demographics
NPI:1588017487
Name:IMANI THERAPIES LLC
Entity Type:Organization
Organization Name:IMANI THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:MBUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:603-793-1906
Mailing Address - Street 1:3 HERSEY ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6430
Mailing Address - Country:US
Mailing Address - Phone:603-793-1906
Mailing Address - Fax:
Practice Address - Street 1:3 HERSEY ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6430
Practice Address - Country:US
Practice Address - Phone:603-793-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1530235Z00000X
MA7390235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty