=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427655257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SPEECH PARADIGM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2020
-----------------------------------------------------
Last Update Date | 10/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4104 RAVENS CREST DR
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-689-0031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 614
-----------------------------------------------------
City | MONMOUTH JUNCTION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08852-0614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-689-0031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MR. SHAWN GUTHREAU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-689-0031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------