Provider Demographics
NPI:1891440632
Name:SPEECH PROFESSIONALS
Entity Type:Organization
Organization Name:SPEECH PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:LARIVE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:402-415-1682
Mailing Address - Street 1:5116 N 176TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-3178
Mailing Address - Country:US
Mailing Address - Phone:402-415-1682
Mailing Address - Fax:
Practice Address - Street 1:5116 N 176TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-3178
Practice Address - Country:US
Practice Address - Phone:402-415-1682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty