Provider Demographics
NPI:1669366696
Name:ALL AGES SPEECH THERAPY
Entity type:Organization
Organization Name:ALL AGES SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MS CCC-SLP
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:OSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-720-8293
Mailing Address - Street 1:16 DESCANSO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9125
Mailing Address - Country:US
Mailing Address - Phone:765-720-8293
Mailing Address - Fax:
Practice Address - Street 1:1500 5TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3480
Practice Address - Country:US
Practice Address - Phone:505-289-1838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech