Provider Demographics
NPI:1710583265
Name:SPECIALTY SPEECH THERAPY LLC
Entity type:Organization
Organization Name:SPECIALTY SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:O'HAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-632-4353
Mailing Address - Street 1:2719 E IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-7184
Mailing Address - Country:US
Mailing Address - Phone:323-632-4353
Mailing Address - Fax:
Practice Address - Street 1:2719 E IOWA AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-7184
Practice Address - Country:US
Practice Address - Phone:323-632-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty