MEDICARE: LANGUAGE LEARNING TECHNOLOGIES, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist		MI

General Provider Information

NPI Number	:	1285623496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANGUAGE LEARNING TECHNOLOGIES, LTD

Provider Business Mailing Address
First Line	:	1635 W BIG BEAVER RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-3501
Country	:	US
Telephone Number	:	248-816-7000
Fax Number	:	248-816-8040

Provider Business Practice Location Address
First Line	:	1635 W BIG BEAVER RD
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-3501
Country	:	US
Telephone Number	:	248-816-7000
Fax Number	:	248-816-8040

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	BEVERLY PHELAN GOUGH
Credential	:	CCC SLP
Telephone Number	:	248-816-7000

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	08/22/2020

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