Provider Demographics
NPI:1396918645
Name:WOODBOURNE SPEECH AND LANGUAGE CENTER, LLC
Entity type:Organization
Organization Name:WOODBOURNE SPEECH AND LANGUAGE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM BANSON
Authorized Official - Middle Name:BANSON
Authorized Official - Last Name:SABOURIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:215-337-9420
Mailing Address - Street 1:81 BIG OAK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7801
Mailing Address - Country:US
Mailing Address - Phone:215-337-9420
Mailing Address - Fax:215-337-9423
Practice Address - Street 1:81 BIG OAK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7801
Practice Address - Country:US
Practice Address - Phone:215-337-9420
Practice Address - Fax:215-337-9423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty