Provider Demographics
NPI:1689019861
Name:CHATTER BUG SPEECH &LANGUAGE THERAPY LLC
Entity Type:Organization
Organization Name:CHATTER BUG SPEECH &LANGUAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:260-515-9240
Mailing Address - Street 1:4666 W JEFFERSON BLVD
Mailing Address - Street 2:STE 144
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6892
Mailing Address - Country:US
Mailing Address - Phone:260-515-9240
Mailing Address - Fax:
Practice Address - Street 1:4666 W JEFFERSON BLVD
Practice Address - Street 2:STE 144
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6892
Practice Address - Country:US
Practice Address - Phone:260-515-9240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005031A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty