Provider Demographics
NPI:1407263767
Name:ANDERSON-SMITH SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:ANDERSON-SMITH SPEECH THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROENEVELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-271-1852
Mailing Address - Street 1:812 SOUTH WHEATLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106
Mailing Address - Country:US
Mailing Address - Phone:605-366-2596
Mailing Address - Fax:
Practice Address - Street 1:6100 W 41ST ST STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-5557
Practice Address - Country:US
Practice Address - Phone:605-271-1852
Practice Address - Fax:844-676-6539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X, 261QX0100X
SD342-SLP252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5842970Medicaid