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General NPI Number Information
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NPI Number | 1881214518
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Entity Type | Organization
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Legal Business Name | ADVANCED TELEPRACTICE ENTERPRISES, LLC
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 5104 76TH ST SE
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City | CALEDONIA
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State | MI
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Zip | 49316-7913
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Country | US
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Telephone | 231-838-5619
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Fax |
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Provider Business Mailing Address
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Address Line | 11880 RACHEL LN
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City | DEWITT
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State | MI
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Zip | 48820-7781
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Country | US
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Telephone | 517-202-7323
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. LAURA LENKE
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Credential | PH.D. CCC-SLP
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Telephone | 231-838-5619
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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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