Healthcare Provider Details

I. General information

NPI: 1215022819
Provider Name (Legal Business Name): SPEECH THERAPY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 HASLETT RD. SUITE 6
HASLETT MI
48840-9475
US

IV. Provider business mailing address

1660 HASLETT RD. SUITE 6
HASLETT MI
48840-9475
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-5691
  • Fax: 517-339-5703
Mailing address:
  • Phone: 517-339-5691
  • Fax: 517-339-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: NANCY GATESY
Title or Position: PRESIDENT
Credential: CCC
Phone: 517-339-5691