Provider Demographics
NPI:1639489677
Name:MENNO HAVEN SPEECH THERAPY
Entity Type:Organization
Organization Name:MENNO HAVEN SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-263-8545
Mailing Address - Street 1:2075 SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1451
Mailing Address - Country:US
Mailing Address - Phone:717-263-6620
Mailing Address - Fax:717-263-1145
Practice Address - Street 1:2075 SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1451
Practice Address - Country:US
Practice Address - Phone:717-263-6620
Practice Address - Fax:717-263-1145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENNO HAVEN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty