Provider Demographics
NPI:1013683929
Name:LIFE SPEECH SERVICES PLLC
Entity type:Organization
Organization Name:LIFE SPEECH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUISE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:484-663-3693
Mailing Address - Street 1:202 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:PA
Mailing Address - Zip Code:17009-1616
Mailing Address - Country:US
Mailing Address - Phone:484-663-3693
Mailing Address - Fax:
Practice Address - Street 1:202 5TH AVE
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1616
Practice Address - Country:US
Practice Address - Phone:484-663-3693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty