Provider Demographics
NPI:1487619235
Name:MAIN LINE SPEECH CONSULTANTS, LTD.
Entity type:Organization
Organization Name:MAIN LINE SPEECH CONSULTANTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC/SLP
Authorized Official - Phone:610-649-8255
Mailing Address - Street 1:626 HAVERFORD RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1102
Mailing Address - Country:US
Mailing Address - Phone:610-649-8255
Mailing Address - Fax:610-649-2924
Practice Address - Street 1:626 HAVERFORD RD
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1102
Practice Address - Country:US
Practice Address - Phone:610-649-8255
Practice Address - Fax:610-649-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000963L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0823890000OtherKEYSTONE
PA2996OtherAETNA
PA885850OtherHIGHMARK BC/BS