Provider Demographics
NPI:1588965834
Name:SPEECH ACADEMY LLC
Entity type:Organization
Organization Name:SPEECH ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:609-372-4613
Mailing Address - Street 1:231 CROSSWICKS RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2602
Mailing Address - Country:US
Mailing Address - Phone:609-372-4613
Mailing Address - Fax:609-372-4618
Practice Address - Street 1:231 CROSSWICKS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2602
Practice Address - Country:US
Practice Address - Phone:609-372-4613
Practice Address - Fax:609-372-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00015200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty