Provider Demographics
NPI:1215290549
Name:INNOVATIVE SPEECH THERAPY INSTITUTE, P.L.L.C.
Entity type:Organization
Organization Name:INNOVATIVE SPEECH THERAPY INSTITUTE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER-SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:VELASQUEZ-ERMATINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC-SLP
Authorized Official - Phone:603-318-6552
Mailing Address - Street 1:108 RIVERWAY PL BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6730
Mailing Address - Country:US
Mailing Address - Phone:603-318-6552
Mailing Address - Fax:
Practice Address - Street 1:108 RIVERWAY PL BLDG 1
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6730
Practice Address - Country:US
Practice Address - Phone:603-318-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty