Healthcare Provider Details

I. General information

NPI: 1992387666
Provider Name (Legal Business Name): ABOVE AND BEYOND SPEECH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S ATHERTON ST STE 101
STATE COLLEGE PA
16801-6255
US

IV. Provider business mailing address

1402 S ATHERTON ST STE 101
STATE COLLEGE PA
16801-6255
US

V. Phone/Fax

Practice location:
  • Phone: 814-954-0288
  • Fax: 814-308-8884
Mailing address:
  • Phone: 814-954-0288
  • Fax: 814-308-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: EMILY M ATEN
Title or Position: OWNER/SLP
Credential:
Phone: 814-954-0288