Provider Demographics
NPI:1053910422
Name:SERENITY SPEECH AND LANGUAGE THERAPY LLC
Entity type:Organization
Organization Name:SERENITY SPEECH AND LANGUAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STANGL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:816-462-8111
Mailing Address - Street 1:8965 W HIGHWAY 116
Mailing Address - Street 2:
Mailing Address - City:GOWER
Mailing Address - State:MO
Mailing Address - Zip Code:64454-8483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8965 W HIGHWAY 116
Practice Address - Street 2:
Practice Address - City:GOWER
Practice Address - State:MO
Practice Address - Zip Code:64454-8483
Practice Address - Country:US
Practice Address - Phone:816-462-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty