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General NPI Number Information
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NPI Number | 1023469566
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPEECH AND LANGUAGE THERAPY, LLC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 1100 ALLISON ST
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City | CROWN POINT
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State | IN
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Zip | 46307-7874
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Country | US
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Telephone | 219-743-3302
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Fax | 219-661-0470
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Provider Business Mailing Address
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Address Line | 1100 ALLISON ST
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City | CROWN POINT
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State | IN
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Zip | 46307-7874
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Country | US
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Telephone | 219-743-3302
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Fax | 219-661-0470
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Authorized Official
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Title or Position | SLP
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Name | MRS. JENNIFER BAKER
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Credential | MA CCC-SLP/L
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Telephone | 219-743-3302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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