Provider Demographics
NPI:1871309088
Name:NEW LIGHT NEUROLOGICAL AND SPEECH THERAPY
Entity type:Organization
Organization Name:NEW LIGHT NEUROLOGICAL AND SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP, CBIS
Authorized Official - Phone:907-351-7140
Mailing Address - Street 1:391 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9443
Mailing Address - Country:US
Mailing Address - Phone:907-351-7140
Mailing Address - Fax:
Practice Address - Street 1:391 OAKWOOD CIR
Practice Address - Street 2:
Practice Address - City:COAL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240-9443
Practice Address - Country:US
Practice Address - Phone:907-351-7140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty