MEDICARE: LANGUAGE AT PLAY SPEECH THERAPY 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	:	1104550193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANGUAGE AT PLAY SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	6622 AVALON FOREST DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6622 AVALON FOREST DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2804
Country	:	US
Telephone Number	:	224-406-6580
Fax Number	:

Authorized Official
Title or Position	:	SOLE MBR
Name	:	SARAH COSTA
Credential	:	MS CCC-SLP
Telephone Number	:	224-406-6580

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	07/14/2022

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Directions to “LANGUAGE AT PLAY SPEECH THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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