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General NPI Number Information
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NPI Number | 1003273343
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Entity Type | Organization
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Legal Business Name | RANDI MICHAEL SPEECH PATHOLOGY, LLC
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 01/18/2016
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Provider Practice Location Address
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Address Line | 934 EASTGATE CT
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City | FRANKENMUTH
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State | MI
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Zip | 48734-1246
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Country | US
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Telephone | 989-598-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 934 EASTGATE CT
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City | FRANKENMUTH
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State | MI
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Zip | 48734-1246
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Country | US
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Telephone | 989-598-0400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RANDI MICHAEL
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Credential |
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Telephone | 989-598-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101001389
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License Number State | MI
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