MEDICARE: DESERT SPEECH AND LANGUAGE CENTER, 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	SP-1055	NV

General Provider Information

NPI Number	:	1508043134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT SPEECH AND LANGUAGE CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 230773
Second Line	:	DESERT SPEECH AND LANGUAGE CENTER, LLC
City	:	LAS VEGAS
State	:	NV
Zip	:	89105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 SPARTAN VIEW CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2878
Country	:	US
Telephone Number	:	702-622-6728
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIM FORNI
Credential	:	M.S. CCC-SLP
Telephone Number	:	702-622-6728

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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