MEDICARE: SPEECH THERAPY ADVENTURES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1063106326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH THERAPY ADVENTURES PLLC

Provider Business Mailing Address
First Line	:	6100 KITAMAYA ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1765
Country	:	US
Telephone Number	:	217-621-4124
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 KITAMAYA ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1765
Country	:	US
Telephone Number	:	217-621-4124
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SLP
Name	:	LONI BERBAUM
Credential	:
Telephone Number	:	217-621-4124

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	10/05/2023

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Directions to “SPEECH THERAPY ADVENTURES PLLC ” Practice Location

Language	Start Address	Practice Location

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