Provider Demographics
NPI:1982884235
Name:ALASKA SPEECH & HEARING CLINIC LLC
Entity Type:Organization
Organization Name:ALASKA SPEECH & HEARING CLINIC LLC
Other - Org Name:LISA M OWENS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:907-562-4550
Mailing Address - Street 1:2401 E 42ND AVE
Mailing Address - Street 2:#101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5391
Mailing Address - Country:US
Mailing Address - Phone:907-562-4550
Mailing Address - Fax:907-562-4554
Practice Address - Street 1:2401 E 42ND AVE
Practice Address - Street 2:#101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5391
Practice Address - Country:US
Practice Address - Phone:907-562-4550
Practice Address - Fax:907-562-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-04
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKSP7673235Z00000X
AKAU7673237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAU 7673Medicaid
AKSP7673Medicaid