Provider Demographics
NPI:1811631104
Name:PLATFORM SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:PLATFORM SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:WINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:920-234-5745
Mailing Address - Street 1:1704 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-2506
Mailing Address - Country:US
Mailing Address - Phone:920-234-5745
Mailing Address - Fax:
Practice Address - Street 1:1704 N 12TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-2506
Practice Address - Country:US
Practice Address - Phone:920-234-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1164802658Medicaid