Provider Demographics
NPI:1891129086
Name:SPEECH- LANGUAGE THERAPY SERVICES
Entity Type:Organization
Organization Name:SPEECH- LANGUAGE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF BILLING COMPANY
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HANSON-BOHL
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING STAFF
Authorized Official - Phone:512-656-3830
Mailing Address - Street 1:4325 LAUREL ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5364
Mailing Address - Country:US
Mailing Address - Phone:907-569-5666
Mailing Address - Fax:866-393-1651
Practice Address - Street 1:4325 LAUREL ST
Practice Address - Street 2:STE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5364
Practice Address - Country:US
Practice Address - Phone:907-569-5666
Practice Address - Fax:866-393-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-24
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKBL22023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMPG0462Medicaid