Provider Demographics
NPI:1750973806
Name:LAKE COUNTY PEDIATRIC SPEECH & LANGUAGE THERAPY, LLC
Entity type:Organization
Organization Name:LAKE COUNTY PEDIATRIC SPEECH & LANGUAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-824-1480
Mailing Address - Street 1:7537 MENTOR AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5463
Mailing Address - Country:US
Mailing Address - Phone:440-567-7166
Mailing Address - Fax:
Practice Address - Street 1:7537 MENTOR AVE STE 303
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5463
Practice Address - Country:US
Practice Address - Phone:440-567-7166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty