Healthcare Provider Details

I. General information

NPI: 1790586824
Provider Name (Legal Business Name): 330 SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 OLDE WINTER TRL
POLAND OH
44514-2870
US

IV. Provider business mailing address

PO BOX 14086
YOUNGSTOWN OH
44514-7086
US

V. Phone/Fax

Practice location:
  • Phone: 330-360-7498
  • Fax: 330-595-4727
Mailing address:
  • Phone: 330-360-7498
  • 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: RAUN D SKYRM
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-256-0533