| Organization Name: | PHENOM SPEECH THERAPY, LLC |
| NPI Number: | 1265727598 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORRIE RILLING (OWNER/MANAGER) |
| Mailing Address: | 9937 Delicate Dew St Las Vegas |
| State: | NV US |
| Postal Code: | 891837153 |
| Phone Number: | 7029858385 |
| Fax Number: | |
| NPI Enumeration Date: | 06/15/2011 |
| NPI Last Update Date: | 06/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP-1264 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NV |
| 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 |