Provider Demographics
NPI:1063237600
Name:LAKESIDE LANGUAGE LLC
Entity type:Organization
Organization Name:LAKESIDE LANGUAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:231-445-5090
Mailing Address - Street 1:196 S 3RD ST # 1
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1710
Mailing Address - Country:US
Mailing Address - Phone:231-445-5090
Mailing Address - Fax:
Practice Address - Street 1:196 S 3RD ST # 1
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-1710
Practice Address - Country:US
Practice Address - Phone:231-445-5090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty