Provider Demographics
NPI:1619392677
Name:CREEKSIDE SPEECH THERAPY
Entity Type:Organization
Organization Name:CREEKSIDE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:719-494-6374
Mailing Address - Street 1:27196 SW BAKER RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-8408
Mailing Address - Country:US
Mailing Address - Phone:719-494-6374
Mailing Address - Fax:866-219-8556
Practice Address - Street 1:27196 SW BAKER RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-8408
Practice Address - Country:US
Practice Address - Phone:719-494-6374
Practice Address - Fax:866-219-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty