Healthcare Provider Details

I. General information

NPI: 1396468559
Provider Name (Legal Business Name): SUNBURY SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6796 LOTT RD
SUNBURY OH
43074-8370
US

IV. Provider business mailing address

6796 LOTT RD
SUNBURY OH
43074-8370
US

V. Phone/Fax

Practice location:
  • Phone: 614-206-3380
  • Fax:
Mailing address:
  • Phone: 614-206-3380
  • 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: LORI RIEDY
Title or Position: OWNER/ SPEECH LANGUAGE PATHOLOGIST
Credential: M.A., CCC-SLP
Phone: 614-206-3380