Provider Demographics
NPI:1144645102
Name:SENSIBLE SPEECH-LANGUAGE PATHOLOGY, INC
Entity type:Organization
Organization Name:SENSIBLE SPEECH-LANGUAGE PATHOLOGY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/SPEECH-LANGUAGE PATHOLOGI
Authorized Official - Prefix:
Authorized Official - First Name:LEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:971-599-1712
Mailing Address - Street 1:PO BOX 12381
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-0381
Mailing Address - Country:US
Mailing Address - Phone:971-599-1712
Mailing Address - Fax:
Practice Address - Street 1:1475 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7850
Practice Address - Country:US
Practice Address - Phone:971-599-1712
Practice Address - Fax:888-835-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500684123Medicaid