Healthcare Provider Details

I. General information

NPI: 1841658283
Provider Name (Legal Business Name): THE SPEECH AND LANGUAGE ADVOCACY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2016
Last Update Date: 01/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26045 RED WOOD DR
NEW BOSTON MI
48164-9188
US

IV. Provider business mailing address

26045 RED WOOD DR
NEW BOSTON MI
48164-9188
US

V. Phone/Fax

Practice location:
  • Phone: 734-315-0117
  • Fax:
Mailing address:
  • Phone: 734-315-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number7101001234
License Number StateMI

VIII. Authorized Official

Name: TOULA CASSANDRA ADU
Title or Position: FOUNDER/SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S. CCC-SLP
Phone: 734-315-0117