Provider Demographics
NPI:1619650850
Name:MOUNT EVERETT SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:MOUNT EVERETT SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:918-208-6894
Mailing Address - Street 1:2102 N CHAMBERS TER
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6234
Mailing Address - Country:US
Mailing Address - Phone:918-208-6894
Mailing Address - Fax:
Practice Address - Street 1:2102 N CHAMBERS TER
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6234
Practice Address - Country:US
Practice Address - Phone:918-208-6894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty