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General NPI Number Information
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NPI Number | 1053025098
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Entity Type | Organization
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Legal Business Name | TRANSFORM SPEECH THERAPY L.L.C.
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 401 HALL ST SW STE 185D
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-6502
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Country | US
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Telephone | 734-834-9927
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Fax |
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Provider Business Mailing Address
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Address Line | 6790 48TH AVE
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City | HUDSONVILLE
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State | MI
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Zip | 49426-9720
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Country | US
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Telephone | 734-834-9927
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Fax |
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | MAYU NASH
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Credential | M.A.
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Telephone | 734-834-9927
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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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