Provider Demographics
NPI:1053001982
Name:OLD SCHOOL SPEECH LLC
Entity type:Organization
Organization Name:OLD SCHOOL SPEECH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NICCI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:LITTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:765-209-2537
Mailing Address - Street 1:10932 W 600 S
Mailing Address - Street 2:
Mailing Address - City:REDKEY
Mailing Address - State:IN
Mailing Address - Zip Code:47373-9352
Mailing Address - Country:US
Mailing Address - Phone:765-209-2537
Mailing Address - Fax:
Practice Address - Street 1:10932 W 600 S
Practice Address - Street 2:
Practice Address - City:REDKEY
Practice Address - State:IN
Practice Address - Zip Code:47373-9352
Practice Address - Country:US
Practice Address - Phone:765-209-2537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty