Provider Demographics
NPI:1154205789
Name:OLIVE BRANCH FEEDING THERAPY PLLC
Entity type:Organization
Organization Name:OLIVE BRANCH FEEDING THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:NORINE
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:815-343-3343
Mailing Address - Street 1:1154 COUNTY ROAD 1800 N
Mailing Address - Street 2:
Mailing Address - City:LOWPOINT
Mailing Address - State:IL
Mailing Address - Zip Code:61545-7511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 W MOUNT VERNON ST STE 3
Practice Address - Street 2:
Practice Address - City:METAMORA
Practice Address - State:IL
Practice Address - Zip Code:61548-7095
Practice Address - Country:US
Practice Address - Phone:309-220-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty