Provider Demographics
NPI:1952827354
Name:SPEECH WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:SPEECH WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER OF COMPANY
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:701-549-3283
Mailing Address - Street 1:9715 129TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:ND
Mailing Address - Zip Code:58282-9731
Mailing Address - Country:US
Mailing Address - Phone:701-549-3283
Mailing Address - Fax:
Practice Address - Street 1:9715 129TH AVE NE
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:ND
Practice Address - Zip Code:58282-9731
Practice Address - Country:US
Practice Address - Phone:701-549-3283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1115OtherNORTH DAKOTA SPEECH-LANGUAGE PATHOLOGY LICENSE