MEDICARE: SPEECH WAY THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1275370595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH WAY THERAPY LLC

Provider Business Mailing Address
First Line	:	8000 WEST DR APT 219
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-5596
Country	:	US
Telephone Number	:	818-916-6452
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 WEST DR APT 219
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-5596
Country	:	US
Telephone Number	:	818-916-6452
Fax Number	:

Authorized Official
Title or Position	:	SLP
Name	:	ERMINE HELEN KHACHERYAN
Credential	:
Telephone Number	:	818-916-6452

Provider Enumeration Date	:	07/12/2024
Last Update Date	:	07/12/2024

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Directions to “SPEECH WAY THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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