Provider Demographics
NPI:1790061786
Name:SPEECH SPOT LLC
Entity Type:Organization
Organization Name:SPEECH SPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:208-514-9243
Mailing Address - Street 1:2300 S ORCHARD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6722
Mailing Address - Country:US
Mailing Address - Phone:208-514-9243
Mailing Address - Fax:208-577-6700
Practice Address - Street 1:2300 S ORCHARD ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6722
Practice Address - Country:US
Practice Address - Phone:208-514-9243
Practice Address - Fax:208-577-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty