Provider Demographics
NPI:1598523086
Name:SPEECH AND FEEDING NEST
Entity Type:Organization
Organization Name:SPEECH AND FEEDING NEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFANI
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-707-1082
Mailing Address - Street 1:PO BOX 2576
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:AZ
Mailing Address - Zip Code:85936-2576
Mailing Address - Country:US
Mailing Address - Phone:480-707-1082
Mailing Address - Fax:
Practice Address - Street 1:1940 W 4TH N
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936-4885
Practice Address - Country:US
Practice Address - Phone:480-707-1082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech