Healthcare Provider Details

I. General information

NPI: 1427983329
Provider Name (Legal Business Name): PEAK PLAY SPEECH THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E SUPERIOR ST
WAYLAND MI
49348-1145
US

IV. Provider business mailing address

615 S MAIN ST
WAYLAND MI
49348-1318
US

V. Phone/Fax

Practice location:
  • Phone: 269-355-0561
  • Fax:
Mailing address:
  • Phone: 269-355-0561
  • 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: MACKENZIE GALBREATH
Title or Position: OWNER - SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 269-355-0561