Provider Demographics
NPI:1639332562
Name:SPEECH & LANGAUGE THERAPY AND REHABILITATION SPECIALISTS
Entity Type:Organization
Organization Name:SPEECH & LANGAUGE THERAPY AND REHABILITATION SPECIALISTS
Other - Org Name:STARS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:262-716-9557
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53170-0536
Mailing Address - Country:US
Mailing Address - Phone:262-716-9557
Mailing Address - Fax:262-721-0733
Practice Address - Street 1:401 E LAKE ST
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:WI
Practice Address - Zip Code:53170-1729
Practice Address - Country:US
Practice Address - Phone:262-716-9557
Practice Address - Fax:262-721-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3058-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty