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General NPI Number Information
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NPI Number | 1295512267
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Entity Type | Organization
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Legal Business Name | INTERAACTIVE SPEECH THERAPY
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3222 W FULLER DR
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City | ANTHEM
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State | AZ
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Zip | 85086-6004
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Country | US
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Telephone | 847-596-0445
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Fax |
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Provider Business Mailing Address
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Address Line | 3222 W FULLER DR
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City | ANTHEM
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State | AZ
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Zip | 85086-6004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH FARISON
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Credential | MS CCC-SLP
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Telephone | 847-596-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 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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