Healthcare Provider Details

I. General information

NPI: 1619681335
Provider Name (Legal Business Name): LITTLE LEADERS SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 E RIO SALADO PKWY APT 4002
TEMPE AZ
85288-7485
US

IV. Provider business mailing address

2325 E RIO SALADO PKWY APT 4002
TEMPE AZ
85288-7485
US

V. Phone/Fax

Practice location:
  • Phone: 248-505-9127
  • Fax:
Mailing address:
  • Phone: 248-505-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNAH MAGID
Title or Position: SPEECH LANGUAGE THERAPIST, OWNER
Credential: M.A., CCC-SLP
Phone: 248-505-9127