Provider Demographics
NPI:1790454817
Name:NWI OROFACIAL MYOFUNCTIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:NWI OROFACIAL MYOFUNCTIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MYOFUNCTIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LASHENIK
Authorized Official - Suffix:
Authorized Official - Credentials:LDH
Authorized Official - Phone:219-661-7271
Mailing Address - Street 1:PO BOX 2425
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-2425
Mailing Address - Country:US
Mailing Address - Phone:219-661-7271
Mailing Address - Fax:
Practice Address - Street 1:566 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3412
Practice Address - Country:US
Practice Address - Phone:219-661-7271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date: