Provider Demographics
NPI:1710450697
Name:EUGENE SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:EUGENE SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:541-301-8901
Mailing Address - Street 1:985 TIARA ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6309
Mailing Address - Country:US
Mailing Address - Phone:541-301-8901
Mailing Address - Fax:541-843-2833
Practice Address - Street 1:385 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-9740
Practice Address - Country:US
Practice Address - Phone:541-600-2028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717634Medicaid
OR1316349509OtherNPI