Provider Demographics
NPI:1659065282
Name:CRICKET SPEECH AND LANGUAGE THERAPY PLLC
Entity Type:Organization
Organization Name:CRICKET SPEECH AND LANGUAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOARDMAN JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-219-7853
Mailing Address - Street 1:7546 E MAJESTIC PALM LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-6112
Mailing Address - Country:US
Mailing Address - Phone:530-219-7853
Mailing Address - Fax:
Practice Address - Street 1:7546 E MAJESTIC PALM LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-6112
Practice Address - Country:US
Practice Address - Phone:530-219-7853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty