MEDICARE: SPEECH BOX LLC

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	:	1063117265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH BOX LLC

Provider Business Mailing Address
First Line	:	5955 EDMOND ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2856
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7635 RIBBON GARLAND CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5411
Country	:	US
Telephone Number	:	702-499-2410
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	GAELLA DOUTIS
Credential	:	CCC-SLP
Telephone Number	:	702-499-2410

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	04/13/2023

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Directions to “SPEECH BOX LLC ” Practice Location

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