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Idaho Pediatric Speech and Language, LLC

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Company Details

Name: Idaho Pediatric Speech and Language, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved (Administrative)
Date of registration: 24 Sep 2021 (4 years ago)
Financial Date End: 30 Sep 2022
Date dissolved: 09 Dec 2022
Entity Number: 4427220
Place of Formation: IDAHO
File Number: 783525
ZIP code: 83642
County: Ada County
Principal Address: 697 N KEAGAN WAY MERIDIAN, ID 83642
Mailing Address: 697 N KEAGAN WAY MERIDIAN, ID 83642-5513

Agent

Name Role Address
Adam Smith Agent 697 N KEAGAN WAY, MERIDIAN, ID 83642-5513

National Provider Identifier

NPI Number:
1528723137
Certification Date:
2021-11-19

Authorized Person:

Name:
KATELYN SMITH
Role:
SPEECH-LANGUAGE PATHOLOGIST
Phone:

Taxonomy:

Selected Taxonomy:
261QH0700X - Hearing and Speech Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Dissolution/Revocation - Administrative 0005024169 2022-12-09
Initial Filing 0004427220 2021-09-24

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Date of last update: 20 May 2025

Sources: Idaho Secretary of State