Provider Demographics
NPI:1588211445
Name:FULL SPECTRUM SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:FULL SPECTRUM SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:608-320-9896
Mailing Address - Street 1:6612 BOULDER LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2807
Mailing Address - Country:US
Mailing Address - Phone:608-320-9896
Mailing Address - Fax:
Practice Address - Street 1:6612 BOULDER LN
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2807
Practice Address - Country:US
Practice Address - Phone:608-320-9896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14480803OtherCAQH