Provider Demographics
NPI:1669197141
Name:ICT SPEECH THERAPY SERVICES LLC
Entity type:Organization
Organization Name:ICT SPEECH THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:MILLSPAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-215-4719
Mailing Address - Street 1:821 N COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6526
Mailing Address - Country:US
Mailing Address - Phone:316-215-4719
Mailing Address - Fax:
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:BLDG 1050, STE D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-6720
Practice Address - Country:US
Practice Address - Phone:316-409-9932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty