Provider Demographics
NPI:1780216580
Name:KELLOGG SPEECH LANGUAGE LEARNING SERVICES
Entity Type:Organization
Organization Name:KELLOGG SPEECH LANGUAGE LEARNING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-730-4110
Mailing Address - Street 1:2302 CRANES CV
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1368
Mailing Address - Country:US
Mailing Address - Phone:810-730-4110
Mailing Address - Fax:
Practice Address - Street 1:8323 OFFICE PARK DR STE C4
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2068
Practice Address - Country:US
Practice Address - Phone:810-730-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty