Provider Demographics
NPI:1023422946
Name:INDEPENDENCE SPEECH THERAPY INC
Entity type:Organization
Organization Name:INDEPENDENCE SPEECH THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THIELGES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:701-883-5464
Mailing Address - Street 1:7274 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LAMOURE
Mailing Address - State:ND
Mailing Address - Zip Code:58458-9409
Mailing Address - Country:US
Mailing Address - Phone:701-883-5464
Mailing Address - Fax:701-883-5464
Practice Address - Street 1:7274 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:LAMOURE
Practice Address - State:ND
Practice Address - Zip Code:58458-9409
Practice Address - Country:US
Practice Address - Phone:701-883-5464
Practice Address - Fax:701-883-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty