Provider Demographics
NPI:1851764310
Name:PANOPTIC SPEECH THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:PANOPTIC SPEECH THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:360-273-0220
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:214 E. PINE STREET
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-0225
Mailing Address - Country:US
Mailing Address - Phone:360-273-0220
Mailing Address - Fax:360-273-5510
Practice Address - Street 1:214 E. PINE STREET
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:WA
Practice Address - Zip Code:98568
Practice Address - Country:US
Practice Address - Phone:360-273-0220
Practice Address - Fax:360-273-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty