Provider Demographics
NPI:1780931485
Name:GREEN MOUNTAIN SPEECH-LANGUAGE AND FEEDING SERVICES, LLC
Entity type:Organization
Organization Name:GREEN MOUNTAIN SPEECH-LANGUAGE AND FEEDING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:AILEEN
Authorized Official - Last Name:ACHOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:917-916-7340
Mailing Address - Street 1:3751 VT ROUTE 153
Mailing Address - Street 2:
Mailing Address - City:WEST PAWLET
Mailing Address - State:VT
Mailing Address - Zip Code:05775-9730
Mailing Address - Country:US
Mailing Address - Phone:917-916-7340
Mailing Address - Fax:802-645-0491
Practice Address - Street 1:3751 VT ROUTE 153
Practice Address - Street 2:
Practice Address - City:WEST PAWLET
Practice Address - State:VT
Practice Address - Zip Code:05775-9730
Practice Address - Country:US
Practice Address - Phone:917-916-7340
Practice Address - Fax:802-645-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT8040574251E00000X, 252Y00000X
NY012403-1251E00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251E00000XAgenciesHome Health