Provider Demographics
NPI:1720239221
Name:THE SPEECH PATHOLOGY LEARNING CENTER, LLC
Entity Type:Organization
Organization Name:THE SPEECH PATHOLOGY LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:CIARLO
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP, MA
Authorized Official - Phone:509-735-6442
Mailing Address - Street 1:8514 W GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8120
Mailing Address - Country:US
Mailing Address - Phone:509-735-6442
Mailing Address - Fax:866-523-1692
Practice Address - Street 1:8514 W GAGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8120
Practice Address - Country:US
Practice Address - Phone:509-735-6442
Practice Address - Fax:866-523-1692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001974225XP0200X
WALL00002194235Z00000X
WALL00004503235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7136526Medicaid