Provider Demographics
NPI:1063106326
Name:SPEECH THERAPY ADVENTURES PLLC
Entity type:Organization
Organization Name:SPEECH THERAPY ADVENTURES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:LONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-621-4124
Mailing Address - Street 1:6100 KITAMAYA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1765
Mailing Address - Country:US
Mailing Address - Phone:217-621-4124
Mailing Address - Fax:
Practice Address - Street 1:6100 KITAMAYA ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1765
Practice Address - Country:US
Practice Address - Phone:217-621-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty