Healthcare Provider Details

I. General information

NPI: 1588027866
Provider Name (Legal Business Name): INNOVATIVE SPEECH & SWALLOWING PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2016
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11330 CLEVELAND AVE NW
UNIONTOWN OH
44685-8078
US

IV. Provider business mailing address

11330 CLEVELAND AVE NW
UNIONTOWN OH
44685-8078
US

V. Phone/Fax

Practice location:
  • Phone: 330-595-9059
  • Fax:
Mailing address:
  • Phone: 330-595-9059
  • Fax: 330-595-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KATIJO MAKIN
Title or Position: OWNER/THERAPIST
Credential: MA, CCC-SLP
Phone: 330-595-9059