Provider Demographics
NPI:1447966890
Name:INNOVATIVE SPEECH SERVICES, LLC
Entity type:Organization
Organization Name:INNOVATIVE SPEECH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:HEZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CCC-SLP
Authorized Official - Phone:913-752-9316
Mailing Address - Street 1:11575 S WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5567
Mailing Address - Country:US
Mailing Address - Phone:913-752-9316
Mailing Address - Fax:
Practice Address - Street 1:11575 S WEBSTER ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5567
Practice Address - Country:US
Practice Address - Phone:913-752-9316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty