Provider Demographics
NPI:1396516951
Name:LIGHT OF MINE PEDIATRIC SPEECH, LLC
Entity type:Organization
Organization Name:LIGHT OF MINE PEDIATRIC SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHILLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-771-5865
Mailing Address - Street 1:328 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:FALLS CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:15840-9642
Mailing Address - Country:US
Mailing Address - Phone:814-771-5865
Mailing Address - Fax:
Practice Address - Street 1:328 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:FALLS CREEK
Practice Address - State:PA
Practice Address - Zip Code:15840-9642
Practice Address - Country:US
Practice Address - Phone:814-771-5865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech