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General NPI Number Information
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NPI Number | 1033862602
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Entity Type | Organization
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Legal Business Name | SPEECH UNBOUND
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/02/2022
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Provider Practice Location Address
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Address Line | 30353 MANSE ST
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City | HARRISON TOWNSHIP
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State | MI
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Zip | 48045-1872
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Country | US
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Telephone | 586-221-0705
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Fax | 833-427-1163
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Provider Business Mailing Address
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Address Line | 36358 GARFIELD RD STE 2
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48035-1152
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Country | US
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Telephone | 586-221-0705
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Fax | 833-427-1163
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Authorized Official
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Title or Position | OWNER
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Name | SARAH RENEE PUVALOWSKI
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Credential | SLP
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Telephone | 586-221-0705
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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 |
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License Number State |
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