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General NPI Number Information
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NPI Number | 1356628457
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Entity Type | Organization
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Legal Business Name | SARATOGA SPEECH THERAPY LLC
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Dates
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Enumeration Date | 11/03/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 4364 CLYDE RD
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City | LANGLEY
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State | WA
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Zip | 98260-9540
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Country | US
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Telephone | 360-221-7404
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Fax |
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Provider Business Mailing Address
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Address Line | 4364 CLYDE RD
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City | LANGLEY
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State | WA
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Zip | 98260-9540
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUE KEBLUSEK
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Credential | MA, CCC-SLP
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Telephone | 360-221-7404
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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 | LL00003239
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License Number State | WA
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