Provider Demographics
NPI:1174729362
Name:SPEECH LANGUAGE AND LEARNING PLACE
Entity type:Organization
Organization Name:SPEECH LANGUAGE AND LEARNING PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKERILL
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC SLP
Authorized Official - Phone:402-774-2091
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:240 WEST 94TH STREET
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-0486
Mailing Address - Country:US
Mailing Address - Phone:402-744-2091
Mailing Address - Fax:402-744-2092
Practice Address - Street 1:240 WEST 94TH STREET
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68902-0486
Practice Address - Country:US
Practice Address - Phone:402-744-2091
Practice Address - Fax:402-744-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty