Provider Demographics
NPI:1902950231
Name:REMEDIAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:REMEDIAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOCHNOUR
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:662-473-0012
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-0594
Mailing Address - Country:US
Mailing Address - Phone:662-473-0012
Mailing Address - Fax:662-473-0013
Practice Address - Street 1:105 N COURT ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-1806
Practice Address - Country:US
Practice Address - Phone:662-473-0012
Practice Address - Fax:662-473-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSV02064770OtherDISABILTY DETERM VENDOR #
MS0786823OtherCIGNA PROVIDER I.D.
MS=========OtherBLU CROSS OF MS ID #