Healthcare Provider Details

I. General information

NPI: 1093400731
Provider Name (Legal Business Name): NEURO SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 NE WHISPER RIDGE DR APT 3
BEND OR
97701-6416
US

IV. Provider business mailing address

1372 NE WHISPER RIDGE DR APT 3
BEND OR
97701-6416
US

V. Phone/Fax

Practice location:
  • Phone: 541-204-1757
  • Fax:
Mailing address:
  • Phone: 541-204-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON KIMBERLY PHILLIPS
Title or Position: OWNER/SLP
Credential: CCC-SLP
Phone: 541-204-1757