Provider Demographics
NPI:1740914431
Name:SPEECH 4 KIDDOS LLC
Entity type:Organization
Organization Name:SPEECH 4 KIDDOS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PANCOAST
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:415-583-3185
Mailing Address - Street 1:4029 NE TILLAMOOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-5341
Mailing Address - Country:US
Mailing Address - Phone:503-272-1867
Mailing Address - Fax:
Practice Address - Street 1:4029 NE TILLAMOOK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5341
Practice Address - Country:US
Practice Address - Phone:503-272-1867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech