Provider Demographics
NPI:1427140896
Name:SPEECH SERVICES OF NORTHEAST ALABAMA, INC.
Entity type:Organization
Organization Name:SPEECH SERVICES OF NORTHEAST ALABAMA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPEECH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:M S CCC-SLP
Authorized Official - Phone:256-831-4669
Mailing Address - Street 1:744 SUNNY EVE RD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4512
Mailing Address - Country:US
Mailing Address - Phone:256-831-4669
Mailing Address - Fax:
Practice Address - Street 1:706 SUNNY EVE RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4512
Practice Address - Country:US
Practice Address - Phone:256-831-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH778225100000X
AL1650225X00000X
AL829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL016568Medicare ID - Type UnspecifiedOUT PATIENT THERAPY