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General NPI Number Information
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NPI Number | 1710583265
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Entity Type | Organization
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Legal Business Name | SPECIALTY SPEECH THERAPY LLC
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 2719 E IOWA AVE
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City | NAMPA
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State | ID
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Zip | 83686-7184
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Country | US
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Telephone | 323-632-4353
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Fax |
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Provider Business Mailing Address
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Address Line | 2719 E IOWA AVE
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City | NAMPA
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State | ID
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Zip | 83686-7184
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Country | US
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Telephone | 323-632-4353
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE MARIE O'HAGAN
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Credential |
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Telephone | 323-632-4353
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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 |
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License Number State |
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