Provider Demographics
NPI:1841985660
Name:SALT & LIGHT SPEECH THERAPY
Entity type:Organization
Organization Name:SALT & LIGHT SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:580-251-0984
Mailing Address - Street 1:3677 OLD HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:RUSH SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:73082-2459
Mailing Address - Country:US
Mailing Address - Phone:580-251-0984
Mailing Address - Fax:405-548-5260
Practice Address - Street 1:4648 HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:RUSH SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:73082-3123
Practice Address - Country:US
Practice Address - Phone:580-251-0984
Practice Address - Fax:405-548-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech