Provider Demographics
NPI:1598222713
Name:SALMON SPEECH AND SWALLOWING SERVICE
Entity Type:Organization
Organization Name:SALMON SPEECH AND SWALLOWING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:208-244-2547
Mailing Address - Street 1:5 S JAKICH DR
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-3104
Mailing Address - Country:US
Mailing Address - Phone:208-244-2547
Mailing Address - Fax:208-993-9397
Practice Address - Street 1:909 SHOUP ST STE 1
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4306
Practice Address - Country:US
Practice Address - Phone:208-244-2547
Practice Address - Fax:208-756-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-24
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20011336Medicaid