Provider Demographics
NPI:1184093114
Name:THE SKILLBUILDING CO-OP, LLC
Entity type:Organization
Organization Name:THE SKILLBUILDING CO-OP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAPIDUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:615-497-0566
Mailing Address - Street 1:4115 ELDER PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-1732
Mailing Address - Country:US
Mailing Address - Phone:615-497-0566
Mailing Address - Fax:615-352-9096
Practice Address - Street 1:4115 ELDER PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-1732
Practice Address - Country:US
Practice Address - Phone:615-497-0566
Practice Address - Fax:615-352-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003082235500000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441017Medicaid