Healthcare Provider Details

I. General information

NPI: 1134436561
Provider Name (Legal Business Name): SLC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 FORD RD #229
WESTLAND MI
48185-3769
US

IV. Provider business mailing address

36500 FORD RD #229
WESTLAND MI
48185-3769
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 Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. LANDRIA MONIQUE SEALS
Title or Position: CEO
Credential: M,A., CCC-SLP
Phone: 866-752-0899