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General NPI Number Information
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NPI Number | 1144533985
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Entity Type | Organization
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Legal Business Name | SPEECH THERAPY PRACTICES, LLC
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Dates
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Enumeration Date | 07/21/2010
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 4513 OLD SHELL RD
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City | MOBILE
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State | AL
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Zip | 36608-1922
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Country | US
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Telephone | 251-382-1152
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Fax |
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Provider Business Mailing Address
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Address Line | 4534 KINGSWOOD DR
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City | MOBILE
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State | AL
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Zip | 36608-2814
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Country | US
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Telephone | 251-377-5457
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MICHELLE KENNEDY SCOTT
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Credential | M.S. CCC SLP
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Telephone | 251-377-5457
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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 | 2514
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License Number State | AL
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