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General NPI Number Information
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NPI Number | 1124740550
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Entity Type | Organization
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Legal Business Name | THIS LITTLE LIGHT SLP, LLC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 13607 E SPRAGUE AVENUE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-0809
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Country | US
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Telephone | 509-991-3064
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Fax | 877-775-2543
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Provider Business Mailing Address
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Address Line | 13607 E SPRAGUE AVENUE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99216-0809
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Country | US
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Telephone | 509-991-3064
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Fax | 877-775-2543
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Authorized Official
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Title or Position | SLP/OWNER
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Name | MRS. SARA DEEANNE NIELSEN
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Credential | MA, CCC/SLP
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Telephone | 509-991-3064
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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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