Provider Demographics
NPI:1881636223
Name:ASSOCIATED SPEECH AND LANGUAGE SPECIALISTS LLC
Entity Type:Organization
Organization Name:ASSOCIATED SPEECH AND LANGUAGE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER AND CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC
Authorized Official - Phone:651-639-0942
Mailing Address - Street 1:561 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-225-4558
Mailing Address - Fax:651-225-9474
Practice Address - Street 1:561 W 7TH ST
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-225-4558
Practice Address - Fax:651-225-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5G054ASOtherBCBS
MN=========OtherHP
MN=========OtherHP