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General NPI Number Information
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NPI Number | 1417228131
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Entity Type | Organization
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Legal Business Name | TMS TASHA MARTIN-STANFORD SPEECH THERAPY SERVICES LLC
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 4820 QUEEN RIDGE AVE #732
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City | KANSAS CITY
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State | MO
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Zip | 64136-1423
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Country | US
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Telephone | 816-373-4841
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Fax | 816-373-4841
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Provider Business Mailing Address
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Address Line | 4820 QUEEN RIDGE AVE #732
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City | KANSAS CITY
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State | MO
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Zip | 64136-1423
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Country | US
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Telephone | 816-373-4841
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Fax | 816-373-4841
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. TASHA R MARTIN-STANFORD
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Credential | M.S.CCC/SLP
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Telephone | 816-373-4841
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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 | 116968
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License Number State | MO
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