Provider Demographics
NPI:1851072268
Name:FRONTIER SPEECH THERAPY
Entity Type:Organization
Organization Name:FRONTIER SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:845-863-6764
Mailing Address - Street 1:1612 KEPNER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2428
Mailing Address - Country:US
Mailing Address - Phone:845-863-6764
Mailing Address - Fax:
Practice Address - Street 1:1612 KEPNER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2428
Practice Address - Country:US
Practice Address - Phone:845-863-6764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service