Provider Demographics
NPI:1174785257
Name:SNOW SPEECH LANGUAGE PATHOLOGY AND REHAB UNLIMITED LLC
Entity type:Organization
Organization Name:SNOW SPEECH LANGUAGE PATHOLOGY AND REHAB UNLIMITED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:O
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:304-728-2820
Mailing Address - Street 1:PO BOX 1217
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-7217
Mailing Address - Country:US
Mailing Address - Phone:304-728-2820
Mailing Address - Fax:304-728-4119
Practice Address - Street 1:113 W LIBERTY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414
Practice Address - Country:US
Practice Address - Phone:304-728-2820
Practice Address - Fax:304-728-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP0297235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty