Provider Demographics
NPI:1871070060
Name:SPEECH BUBBLES, LLC
Entity type:Organization
Organization Name:SPEECH BUBBLES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:360-279-8220
Mailing Address - Street 1:390 NE MIDWAY BLVD STE B202
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2680
Mailing Address - Country:US
Mailing Address - Phone:360-279-8220
Mailing Address - Fax:360-279-8221
Practice Address - Street 1:390 NE MIDWAY BLVD STE B202
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2680
Practice Address - Country:US
Practice Address - Phone:360-279-8220
Practice Address - Fax:360-279-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235151531OtherINDIVIDUAL NPI