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General NPI Number Information
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NPI Number | 1063237600
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Entity Type | Organization
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Legal Business Name | LAKESIDE LANGUAGE LLC
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Dates
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Enumeration Date | 11/19/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 196 S 3RD ST # 1
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City | ROGERS CITY
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State | MI
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Zip | 49779-1710
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Country | US
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Telephone | 231-445-5090
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Fax |
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Provider Business Mailing Address
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Address Line | 196 S 3RD ST # 1
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City | ROGERS CITY
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State | MI
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Zip | 49779-1710
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Country | US
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Telephone | 231-445-5090
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHELBY CARRIER
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Credential | SLP
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Telephone | 231-445-5090
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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 |
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License Number State |
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Taxonomy #2
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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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