Provider Demographics
NPI:1386719300
Name:SPEECH PATHOLOGY ASSOCIATES
Entity type:Organization
Organization Name:SPEECH PATHOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LUDWIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CCC SP
Authorized Official - Phone:573-204-0490
Mailing Address - Street 1:215 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1821
Mailing Address - Country:US
Mailing Address - Phone:573-204-0490
Mailing Address - Fax:573-204-0009
Practice Address - Street 1:215 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-1821
Practice Address - Country:US
Practice Address - Phone:573-204-0490
Practice Address - Fax:573-204-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO857644603Medicaid