1669250890 NPI number — EVERETT SPEECH CONNECTION, LLC

Table of content: (NPI 1669250890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669250890 NPI number — EVERETT SPEECH CONNECTION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERETT SPEECH CONNECTION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1669250890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1013 SW TWIN CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEES SUMMIT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64081-3213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1013 SW TWIN CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64081-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-514-6462
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2023

Additional Information

Authorized Official

Authorized Official Last Name:
EVERETT
Authorized Official First Name:
JOLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
816-514-6462

Provider Taxonomy Codes

  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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