Provider Demographics
NPI:1134414345
Name:SEASTAR SPEECH THERAPY LLC
Entity type:Organization
Organization Name:SEASTAR SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:719-538-6027
Mailing Address - Street 1:1255 LAKE PLAZA DR
Mailing Address - Street 2:SUITE269
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3500
Mailing Address - Country:US
Mailing Address - Phone:719-538-6027
Mailing Address - Fax:719-344-2328
Practice Address - Street 1:1255 LAKE PLAZA DR
Practice Address - Street 2:SUITE269
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3500
Practice Address - Country:US
Practice Address - Phone:719-538-6027
Practice Address - Fax:719-344-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO01129463261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech