Healthcare Provider Details

I. General information

NPI: 1417454612
Provider Name (Legal Business Name): THE AAC SPEECH CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 W SUNSET RD STE 204
LAS VEGAS NV
89148-4903
US

IV. Provider business mailing address

10300 W CHARLESTON BLVD, SUITE 13-J19
LAS VEGAS NV
89135-5008
US

V. Phone/Fax

Practice location:
  • Phone: 702-355-9862
  • Fax: 888-316-4826
Mailing address:
  • Phone: 702-355-9862
  • Fax: 888-316-4826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-2267
License Number StateNV

VIII. Authorized Official

Name: MRS. KATHERINE HANTA WALLISCH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.S. CCC-SLP
Phone: 702-355-9862