Provider Demographics
NPI:1982334553
Name:ACHIEVE SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:ACHIEVE SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SMYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:610-248-8061
Mailing Address - Street 1:4119 W DRESDEN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-8404
Mailing Address - Country:US
Mailing Address - Phone:610-248-8061
Mailing Address - Fax:
Practice Address - Street 1:4119 W DRESDEN DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-8404
Practice Address - Country:US
Practice Address - Phone:610-248-8061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255976700OtherINDIVIDUAL NPI