1639332562 NPI number — SPEECH & LANGAUGE THERAPY AND REHABILITATION SPECIALISTS

Table of content: (NPI 1639332562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639332562 NPI number — SPEECH & LANGAUGE THERAPY AND REHABILITATION SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH & LANGAUGE THERAPY AND REHABILITATION SPECIALISTS
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:
STARS
Provider Other Organization Name Type Code:
3
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:
1639332562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 536
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER LAKE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53170-0536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-716-9557
Provider Business Mailing Address Fax Number:
262-721-0733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 E LAKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER LAKE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53170-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-716-9557
Provider Business Practice Location Address Fax Number:
262-721-0733
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SINGLETON
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
262-716-9557

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  3058-154 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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