Provider Demographics
NPI:1255561833
Name:SPEECH LANGUAGE INTERVENTION STRATEGIES, SPEECHLIS, LLC
Entity type:Organization
Organization Name:SPEECH LANGUAGE INTERVENTION STRATEGIES, SPEECHLIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANAGUAGEPATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:757-952-4217
Mailing Address - Street 1:3710 KECOUGHTAN RD APT A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3710 KECOUGHTAN RD APT A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4429
Practice Address - Country:US
Practice Address - Phone:757-952-4217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty