Provider Demographics
NPI:1184280729
Name:ELITE DYSPHAGIA DIAGNOSTICS & SPEECH SERVICES, LLC
Entity type:Organization
Organization Name:ELITE DYSPHAGIA DIAGNOSTICS & SPEECH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:RANDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:573-225-3639
Mailing Address - Street 1:312 STEPPING STONE WAY
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-8388
Mailing Address - Country:US
Mailing Address - Phone:573-225-3639
Mailing Address - Fax:
Practice Address - Street 1:2137 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5817
Practice Address - Country:US
Practice Address - Phone:573-803-3338
Practice Address - Fax:844-579-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty