Provider Demographics
NPI:1285907295
Name:INLAND SPEECH PATHOLOGY LLC
Entity type:Organization
Organization Name:INLAND SPEECH PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHUTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CCC
Authorized Official - Phone:509-448-5970
Mailing Address - Street 1:PO BOX 30621
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3010
Mailing Address - Country:US
Mailing Address - Phone:509-448-5970
Mailing Address - Fax:509-448-1474
Practice Address - Street 1:2611 E MORAN VISTA LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-2101
Practice Address - Country:US
Practice Address - Phone:509-448-5970
Practice Address - Fax:509-448-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty