Provider Demographics
NPI:1134983794
Name:SAND CANYON THERAPY LLC
Entity type:Organization
Organization Name:SAND CANYON THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENILEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:308-760-8431
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:HEMINGFORD
Mailing Address - State:NE
Mailing Address - Zip Code:69348-0794
Mailing Address - Country:US
Mailing Address - Phone:308-760-8431
Mailing Address - Fax:
Practice Address - Street 1:720 BOX BUTTE AVE
Practice Address - Street 2:
Practice Address - City:HEMINGFORD
Practice Address - State:NE
Practice Address - Zip Code:69348-9706
Practice Address - Country:US
Practice Address - Phone:308-760-8431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty