Provider Demographics
NPI:1306529557
Name:ESSENTIAL SPEECH AND LANGUAGE, LLC
Entity type:Organization
Organization Name:ESSENTIAL SPEECH AND LANGUAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:321-514-2014
Mailing Address - Street 1:9718 PONDEROSA SKYE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-3808
Mailing Address - Country:US
Mailing Address - Phone:321-514-2014
Mailing Address - Fax:
Practice Address - Street 1:9718 PONDEROSA SKYE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-3808
Practice Address - Country:US
Practice Address - Phone:321-514-2014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty