Healthcare Provider Details

I. General information

NPI: 1457792095
Provider Name (Legal Business Name): REACH FOR SPEECH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 BRODHEAD RD SUITE A
ALIQUIPPA PA
15001-1261
US

IV. Provider business mailing address

112 VALLEYVIEW AVE
ALIQUIPPA PA
15001-4735
US

V. Phone/Fax

Practice location:
  • Phone: 724-888-2548
  • Fax: 724-888-2913
Mailing address:
  • Phone: 724-888-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL006251L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBRA ANN WYGANT
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA, CCC-SLP
Phone: 724-888-2548