Provider Demographics
NPI:1821731415
Name:LIFESPAN SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:LIFESPAN SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:907-978-4580
Mailing Address - Street 1:290 ELWOOD DAVIS RD STE 222
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6193
Mailing Address - Country:US
Mailing Address - Phone:907-978-4580
Mailing Address - Fax:
Practice Address - Street 1:290 ELWOOD DAVIS RD STE 222
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6193
Practice Address - Country:US
Practice Address - Phone:907-978-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty