MEDICARE: SILVER LAKE 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	:	1356648125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER LAKE SPEECH THERAPY, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 45
Second Line	:
City	:	SILVER LAKE
State	:	NH
Zip	:	03875-0045
Country	:	US
Telephone Number	:	603-662-9611
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 WALNUT LOOP
Second Line	:
City	:	SILVER LAKE
State	:	NH
Zip	:	03875-6112
Country	:	US
Telephone Number	:	603-662-9611
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH FREEDMAN
Credential	:	MS CCC-SLP
Telephone Number	:	603-662-9611

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	09/22/2014

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Directions to “SILVER LAKE SPEECH THERAPY, LLC. ” Practice Location

Language	Start Address	Practice Location

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