| Organization Name: | SPEECH PATHOLOGY ASSOCIATES LLC |
| NPI Number: | 1225495054 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KENNETH BLUMENTHAL (PRESIDENT) |
| Mailing Address: | 5521 W Lincoln Hwy Suite 100 Crown Point |
| State: | IN US |
| Postal Code: | 463071097 |
| Phone Number: | 2197566100 |
| Fax Number: | 2197566111 |
| NPI Enumeration Date: | 01/25/2016 |
| NPI Last Update Date: | 01/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 22003634A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |