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General NPI Number Information
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NPI Number | 1073854881
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Entity Type | Organization
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Legal Business Name | MOBILE SPEECH FOR CHILDREN LLC
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 853 WESTCHESTER RD
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1827
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Country | US
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Telephone | 313-919-8004
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Fax |
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Provider Business Mailing Address
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Address Line | 853 WESTCHESTER RD
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1827
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Country | US
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Telephone | 313-919-8004
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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 | MS. DEBRA SUTHERLAND
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Credential | CCC-SLP
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Telephone | 313-919-8004
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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 | 7101000353
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License Number State | MI
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