Provider Demographics
NPI:1952970063
Name:SALT & LIGHT SPEECH-LANGUAGE RESOURCES LLC
Entity Type:Organization
Organization Name:SALT & LIGHT SPEECH-LANGUAGE RESOURCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:MAVRAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-582-7717
Mailing Address - Street 1:400 VESTAVIA PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3784
Mailing Address - Country:US
Mailing Address - Phone:205-582-7717
Mailing Address - Fax:205-855-3017
Practice Address - Street 1:400 VESTAVIA PKWY STE 135
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3784
Practice Address - Country:US
Practice Address - Phone:205-582-7717
Practice Address - Fax:205-855-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty