Provider Demographics
NPI:1588754808
Name:OVER THE MOUNTAIN SPEECH, LANGUAGE, AND LEARNING SERVICES, LLC
Entity type:Organization
Organization Name:OVER THE MOUNTAIN SPEECH, LANGUAGE, AND LEARNING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:HENDRIX
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:205-531-8998
Mailing Address - Street 1:1050 LAKE COLONY LN
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7405
Mailing Address - Country:US
Mailing Address - Phone:205-531-8998
Mailing Address - Fax:205-970-4122
Practice Address - Street 1:4231 DOLLY RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-531-8998
Practice Address - Fax:205-970-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-00707OtherBLUECROSS/BLUESHIELD PROV
AL510-01141OtherBLUECROSS/BLUESHIELD PROV
AL515-33411OtherBLUECROSS/BLUESHIELD PROV
AL515-33731OtherBLUECROSS/BLUESHIELD PROV
AL515-29582OtherBLUECROSS/BLUESHIELD PROV
AL515-31438OtherBLUECROSS/BLUESHIELD PROV
AL515-26698OtherBLUECROSS/BLUESHIELD PROV
AL515-30480OtherBLUECROSS/BLUESHIELD PROV
AL515-30858OtherBLUECROSS/BLUESHIELD PROV
AL515-30645OtherBLUECROSS/BLUESHIELD PROV
AL510-01381OtherBLUECROSS/BLUESHIELD PROV
AL515-29574OtherBLUECROSS/BLUESHIELD PROV
AL515-33809OtherBLUECROSS/BLUESHIELD PROV
AL510-00761OtherBLUECROSS/BLUESHIELD PROV
AL515-29553OtherBLUECROSS/BLUESHIELD PROV
AL515-34168OtherBLUECROSS/BLUESHIELD PROV