Healthcare Provider Details

I. General information

NPI: 1306683057
Provider Name (Legal Business Name): AUTHENTIC SPEECH PVD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 WEALTH AVE APT 3
PROVIDENCE RI
02908-5326
US

IV. Provider business mailing address

47 WEALTH AVE APT 3
PROVIDENCE RI
02908-5326
US

V. Phone/Fax

Practice location:
  • Phone: 401-680-0849
  • Fax:
Mailing address:
  • Phone: 401-678-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KILLA MUNOZ
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS, CCC-SLP
Phone: 401-680-0849