Healthcare Provider Details

I. General information

NPI: 1841878444
Provider Name (Legal Business Name): THRIVE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 APOLLO ST
SILVER LAKE KS
66539-9611
US

IV. Provider business mailing address

PO BOX 481
SILVER LAKE KS
66539-0481
US

V. Phone/Fax

Practice location:
  • Phone: 913-575-3697
  • Fax:
Mailing address:
  • Phone: 913-575-3697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GENA ROSSOW
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 913-575-3697