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General NPI Number Information
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NPI Number | 1346851862
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Entity Type | Organization
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Legal Business Name | MY SPEECH POCKET, LLC
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 6155 DERBY WAY
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City | RUTHER GLEN
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State | VA
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Zip | 22546-2753
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Country | US
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Telephone | 804-390-5599
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Fax |
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Provider Business Mailing Address
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Address Line | 6155 DERBY WAY
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City | RUTHER GLEN
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State | VA
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Zip | 22546-2753
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Country | US
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Telephone | 804-390-5599
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Fax |
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Authorized Official
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Title or Position | OWNER/SLP
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Name | MACY GRATHWOL
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Credential | MSED CCC-SLP
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Telephone | 804-390-5599
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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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