Provider Demographics
NPI:1790065431
Name:OG SPEECH SERVICE INC
Entity Type:Organization
Organization Name:OG SPEECH SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:JANELEE
Authorized Official - Last Name:RHINESS-O'GARA
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:270-313-6500
Mailing Address - Street 1:160 KOOSTRA RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-9461
Mailing Address - Country:US
Mailing Address - Phone:270-313-6500
Mailing Address - Fax:866-688-7518
Practice Address - Street 1:160 KOOSTRA RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-9461
Practice Address - Country:US
Practice Address - Phone:270-313-6500
Practice Address - Fax:866-688-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty