Healthcare Provider Details

I. General information

NPI: 1912553553
Provider Name (Legal Business Name): SPEECH THERAPY TIME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 E COUNTY DOWN DR
CHANDLER AZ
85249-7342
US

IV. Provider business mailing address

4708 E COUNTY DOWN DR
CHANDLER AZ
85249-7342
US

V. Phone/Fax

Practice location:
  • Phone: 480-710-5835
  • Fax:
Mailing address:
  • Phone: 480-710-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DOMENIK SPALETA
Title or Position: OWNER / SLPA
Credential: LICENSE # SLPA7124
Phone: 480-710-5835