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General NPI Number Information
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NPI Number | 1033653001
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Entity Type | Organization
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Legal Business Name | OPEN DOORS SPEECH THERAPY LLC
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Dates
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Enumeration Date | 12/11/2016
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Last Update Date | 12/11/2016
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Provider Practice Location Address
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Address Line | 629 E HARRISON ST
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City | REPUBLIC
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State | MO
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Zip | 65738-1324
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Country | US
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Telephone | 417-818-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 638 S MAPLE AVE
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City | REPUBLIC
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State | MO
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Zip | 65738-2219
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Country | US
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Telephone | 417-818-8011
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DENISE WINGO
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Credential | MS CCC-SLP
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Telephone | 417-818-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 2013017261
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License Number State | MO
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