Healthcare Provider Details

I. General information

NPI: 1962798975
Provider Name (Legal Business Name): SLC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29240 BUCKINGHAM SUITE 1
LIVONIA MI
48154
US

IV. Provider business mailing address

36500 FORD ROAD #229
WESTLAND MI
48185
US

V. Phone/Fax

Practice location:
  • Phone: 866-752-0899
  • Fax: 203-604-0602
Mailing address:
  • Phone: 866-752-0899
  • Fax: 203-604-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number003069
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number003069
License Number StateCT

VIII. Authorized Official

Name: LANDRIA SEALS GREEN
Title or Position: EXECUTIVE DIRECTOR
Credential: M.A., CCC-SLP
Phone: 866-752-0899