Provider Demographics
NPI:1679719132
Name:PREMIER SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:PREMIER SPEECH THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:603-818-4448
Mailing Address - Street 1:80 NASHUA RD, BLDG B, UNIT 4
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3426
Mailing Address - Country:US
Mailing Address - Phone:603-818-4448
Mailing Address - Fax:603-818-8704
Practice Address - Street 1:80 NASHUA RD, BLDG B, UNIT 4
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3426
Practice Address - Country:US
Practice Address - Phone:603-818-4448
Practice Address - Fax:603-818-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30407232Medicaid