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General NPI Number Information
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NPI Number | 1588017487
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Entity Type | Organization
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Legal Business Name | IMANI THERAPIES LLC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 3 HERSEY ST
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City | BEDFORD
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State | NH
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Zip | 03110-6430
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Country | US
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Telephone | 603-793-1906
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Fax |
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Provider Business Mailing Address
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Address Line | 3 HERSEY ST
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City | BEDFORD
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State | NH
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Zip | 03110-6430
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Country | US
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Telephone | 603-793-1906
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Fax |
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Authorized Official
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Title or Position | MANAGER/SPEECH LANGUAGE PATHOLOGIST
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Name | BETH THERESE MBUGA
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Credential | M.S. CCC-SLP
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Telephone | 603-793-1906
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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 | 1530
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License Number State | NH
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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 | 7390
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License Number State | MA
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