Provider Demographics
NPI:1891869897
Name:HENDERSON SPEECH HEARING AND LANGUAGE CENTER LLC
Entity Type:Organization
Organization Name:HENDERSON SPEECH HEARING AND LANGUAGE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:702-733-8255
Mailing Address - Street 1:331 N BUFFALO DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0300
Mailing Address - Country:US
Mailing Address - Phone:702-733-8255
Mailing Address - Fax:702-737-8255
Practice Address - Street 1:331 N BUFFALO DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0300
Practice Address - Country:US
Practice Address - Phone:702-733-8255
Practice Address - Fax:702-737-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507443Medicaid