Provider Demographics
NPI:1861200024
Name:PROFESSIONAL SPEECH-LANGUAGE SERVICES
Entity type:Organization
Organization Name:PROFESSIONAL SPEECH-LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:812-219-9824
Mailing Address - Street 1:3626 S EDDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8740
Mailing Address - Country:US
Mailing Address - Phone:812-219-9824
Mailing Address - Fax:
Practice Address - Street 1:3626 S EDDINGTON DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-8740
Practice Address - Country:US
Practice Address - Phone:812-219-9824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty