1215534672 NPI number — KEY 2 SPEECH LLC

Table of content: (NPI 1215534672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215534672 NPI number — KEY 2 SPEECH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEY 2 SPEECH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215534672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8226 S BLUCKSBERG MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STURGIS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57785-2821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-347-0660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8226 S BLUCKSBERG MOUNTAIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STURGIS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57785-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-347-0660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DEROUCHEY
Authorized Official First Name:
LONDA
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
605-347-0660

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1892 . This is a "NORTH DAKOTA STATE BOARD OF EXAMINERS ON AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: S52664 . This is a "MEDICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 581-SLP . This is a "SOUTH DAKOTA BOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5843992 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12113942 . This is a "AMERICAN SPEECH HEARING ASSOCIATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: SLP12665 . This is a "ARIZONA DEPARTMENT OF HEALTH SERVICESS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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