Provider Demographics
NPI:1134640329
Name:TAKE HOME SPEECH LLC
Entity type:Organization
Organization Name:TAKE HOME SPEECH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CARMA
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:SHAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:907-395-0348
Mailing Address - Street 1:37397 CETACEA LN
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8778
Mailing Address - Country:US
Mailing Address - Phone:907-395-0348
Mailing Address - Fax:844-548-5674
Practice Address - Street 1:37397 CETACEA LN
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8778
Practice Address - Country:US
Practice Address - Phone:907-395-0348
Practice Address - Fax:844-548-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK530235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty