Provider Demographics
NPI: | 1952160434 |
---|---|
Name: | ENLIGHTENED SPEECH PATHOLOGY SERVICES PLLC |
Entity Type: | Organization |
Organization Name: | ENLIGHTENED SPEECH PATHOLOGY SERVICES PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SPEECH LANGUAGE PATHOLOGIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALISSA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ALLISON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MS, CCC-SLP |
Authorized Official - Phone: | 507-369-3136 |
Mailing Address - Street 1: | 2612 BAYVIEW SOUTH KNL |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBERT LEA |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 56007-4014 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2612 BAYVIEW SOUTH KNL |
Practice Address - Street 2: | |
Practice Address - City: | ALBERT LEA |
Practice Address - State: | MN |
Practice Address - Zip Code: | 56007-4014 |
Practice Address - Country: | US |
Practice Address - Phone: | 507-369-3136 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-03-18 |
Last Update Date: | 2024-04-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |