Provider Demographics
NPI:1780080341
Name:DREAMCATCHER SPEECH AND LANGUAGE LLC
Entity type:Organization
Organization Name:DREAMCATCHER SPEECH AND LANGUAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:STATEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:662-934-9885
Mailing Address - Street 1:146 YOCONA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6904
Mailing Address - Country:US
Mailing Address - Phone:662-934-9885
Mailing Address - Fax:
Practice Address - Street 1:146 YOCONA RIDGE RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-6904
Practice Address - Country:US
Practice Address - Phone:662-934-9885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty