Provider Demographics
NPI:1790473700
Name:EISENMAN SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:EISENMAN SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:EISENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:707-364-2013
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:ESTER
Mailing Address - State:AK
Mailing Address - Zip Code:99725-0507
Mailing Address - Country:US
Mailing Address - Phone:707-404-3129
Mailing Address - Fax:
Practice Address - Street 1:1528 BLUEGRASS DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5635
Practice Address - Country:US
Practice Address - Phone:707-404-3129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty