=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548079478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPER SPEECH THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2025
-----------------------------------------------------
Last Update Date | 12/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11242 STRANG LINE RD
-----------------------------------------------------
City | LENEXA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66215-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-343-1505
-----------------------------------------------------
Fax | 913-355-1447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24071 W 124TH ST
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-6130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-980-4277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | NICOLETTE M GRIFFITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-980-4277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------