Healthcare Provider Details

I. General information

NPI: 1710494737
Provider Name (Legal Business Name): SPEECH WORKS SPENCER COUNTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 12/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2072 N COUNTY ROAD 700 W
RICHLAND IN
47634-9480
US

IV. Provider business mailing address

2740 W OLD STATE ROAD 45
ROCKPORT IN
47635-8232
US

V. Phone/Fax

Practice location:
  • Phone: 812-359-4012
  • Fax:
Mailing address:
  • Phone: 812-549-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIN

VIII. Authorized Official

Name: MRS. TANYA COWANS
Title or Position: OWNER/SOLE MEMBER
Credential: MS CCC-SLP
Phone: 812-549-6235