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General NPI Number Information
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NPI Number | 1518741685
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Entity Type | Organization
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Legal Business Name | GREATER REACH SPEECH LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 14 COUNTRY TRAIL CT
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-5834
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Country | US
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Telephone | 319-215-5809
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Fax |
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Provider Business Mailing Address
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Address Line | 14 COUNTRY TRAIL CT
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-5834
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Country | US
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Telephone | 319-215-5809
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Fax |
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Authorized Official
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Title or Position | OWNER, SPEECH LANGUAGE PATHOLOGIST
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Name | LUCINDA WILKINSON
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Credential | CCC-SLP
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Telephone | 319-215-5809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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