Provider Demographics
NPI:1548967912
Name:SPEECH FOR PETITES, LLC
Entity type:Organization
Organization Name:SPEECH FOR PETITES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUONG
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:316-519-1795
Mailing Address - Street 1:4413 KOEHLER ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3592
Mailing Address - Country:US
Mailing Address - Phone:316-519-1795
Mailing Address - Fax:
Practice Address - Street 1:1100 HERCULES AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2797
Practice Address - Country:US
Practice Address - Phone:316-519-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417497884OtherBLUE CROSS BLUE SHIELD