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General NPI Number Information
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NPI Number | 1013712959
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Entity Type | Organization
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Legal Business Name | NEBULA SPEECH THERAPY
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 622 S SHELDON ST
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City | CHARLOTTE
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State | MI
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Zip | 48813-1848
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Country | US
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Telephone | 517-554-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 622 S SHELDON ST
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City | CHARLOTTE
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State | MI
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Zip | 48813-1848
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Country | US
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Telephone | 517-554-0070
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. MAKENZI FARMER
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Credential | M.A,
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Telephone | 517-554-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA3000X
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Taxonomy Name | Augmentative Communication Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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