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General NPI Number Information
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NPI Number | 1811631104
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Entity Type | Organization
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Legal Business Name | PLATFORM SPEECH THERAPY LLC
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Dates
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Enumeration Date | 04/23/2022
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Last Update Date | 04/23/2022
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Provider Practice Location Address
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Address Line | 1704 N 12TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-2506
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Country | US
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Telephone | 920-234-5745
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Fax |
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Provider Business Mailing Address
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Address Line | 1704 N 12TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-2506
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Country | US
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Telephone | 920-234-5745
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Fax |
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Authorized Official
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Title or Position | OWNER/SLP
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Name | MISS KRISTIN N WINKEL
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Credential | MA, CCC-SLP
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Telephone | 920-234-5745
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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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