Provider Demographics
NPI:1124609383
Name:LATITUDE SPEECH THERAPY LLC
Entity type:Organization
Organization Name:LATITUDE SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:201-406-3356
Mailing Address - Street 1:304 ESSEX ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3420
Mailing Address - Country:US
Mailing Address - Phone:201-406-3356
Mailing Address - Fax:
Practice Address - Street 1:304 ESSEX ST UNIT 3
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3420
Practice Address - Country:US
Practice Address - Phone:201-406-3356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech