1851892384 NPI number — SPEECH AND LANGUAGE SERVICES LLC DBA IMPACT PEDIATRIC THERAPY

Table of content: (NPI 1851892384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851892384 NPI number — SPEECH AND LANGUAGE SERVICES LLC DBA IMPACT PEDIATRIC THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH AND LANGUAGE SERVICES LLC DBA IMPACT PEDIATRIC THERAPY
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:
6
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:
1851892384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 BABCOCK BLVD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15237-2564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-879-0499
Provider Business Mailing Address Fax Number:
412-291-1150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 BABCOCK BLVD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-879-0499
Provider Business Practice Location Address Fax Number:
412-291-1150
Provider Enumeration Date:
02/21/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEHR
Authorized Official First Name:
LAUREN
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official Telephone Number:
412-879-0499

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL013419 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1034646880001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".