Provider Demographics
NPI: | 1629693486 |
---|---|
Name: | FLIGHT SPEECH THERAPY, LLC |
Entity Type: | Organization |
Organization Name: | FLIGHT SPEECH THERAPY, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF CLINIC OPERATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEVEN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HALL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 479-431-6141 |
Mailing Address - Street 1: | 202 N WALTON BLVD STE 34 |
Mailing Address - Street 2: | |
Mailing Address - City: | BENTONVILLE |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72712-5175 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 479-431-6141 |
Mailing Address - Fax: | 479-282-0414 |
Practice Address - Street 1: | 202 N WALTON BLVD STE 34 |
Practice Address - Street 2: | |
Practice Address - City: | BENTONVILLE |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72712-5175 |
Practice Address - Country: | US |
Practice Address - Phone: | 479-431-6141 |
Practice Address - Fax: | 479-262-0414 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-06-08 |
Last Update Date: | 2022-08-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |