Provider Demographics
NPI:1811662943
Name:CORNERSTONE PEDIATRIC SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:CORNERSTONE PEDIATRIC SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OSTERHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:208-319-4360
Mailing Address - Street 1:423 W BUTTONBUSH DR
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-4714
Mailing Address - Country:US
Mailing Address - Phone:208-319-4360
Mailing Address - Fax:
Practice Address - Street 1:423 W BUTTONBUSH DR
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-4714
Practice Address - Country:US
Practice Address - Phone:208-319-4360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty