Provider Demographics
NPI:1639553167
Name:BIRDSONG SPEECH THERAPY ASSOCIATES, LLC
Entity type:Organization
Organization Name:BIRDSONG SPEECH THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:541-371-2782
Mailing Address - Street 1:845 E 43RD AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-5308
Mailing Address - Country:US
Mailing Address - Phone:541-371-2782
Mailing Address - Fax:
Practice Address - Street 1:845 E 43RD AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-5308
Practice Address - Country:US
Practice Address - Phone:541-371-2782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15420235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty