Provider Demographics
NPI:1023469566
Name:PEDIATRIC SPEECH AND LANGUAGE THERAPY, LLC
Entity type:Organization
Organization Name:PEDIATRIC SPEECH AND LANGUAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP/L
Authorized Official - Phone:219-743-3302
Mailing Address - Street 1:1100 ALLISON ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7874
Mailing Address - Country:US
Mailing Address - Phone:219-743-3302
Mailing Address - Fax:219-661-0470
Practice Address - Street 1:1100 ALLISON ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7874
Practice Address - Country:US
Practice Address - Phone:219-743-3302
Practice Address - Fax:219-661-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty