1710328471 NPI number — ACCELL SPEECH THERAPY, LLC

Table of content: (NPI 1710328471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710328471 NPI number — ACCELL SPEECH THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCELL SPEECH THERAPY, 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:
1710328471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11404 W RADCLIFF ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAMPA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83651-5049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-461-1774
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11404 W RADCLIFF ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83651-5049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-461-1774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SPARKUHL
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
208-461-1774

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP-1802 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SLP-1802 . This is a "STATE OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 12125479 . This is a "AMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".