Provider Demographics
NPI:1063742849
Name:INNOVATIVE SPEECH THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:INNOVATIVE SPEECH THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORNE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:318-312-2294
Mailing Address - Street 1:302 BUSHLEY STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARRISONBURG
Mailing Address - State:LA
Mailing Address - Zip Code:71340
Mailing Address - Country:US
Mailing Address - Phone:318-312-2294
Mailing Address - Fax:318-744-5368
Practice Address - Street 1:302 BUSHLEY STREET
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISONBURG
Practice Address - State:LA
Practice Address - Zip Code:71340
Practice Address - Country:US
Practice Address - Phone:318-312-2294
Practice Address - Fax:318-744-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4723235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty