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General NPI Number Information
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NPI Number | 1669017620
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Entity Type | Organization
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Legal Business Name | LOGOS SPEECH THERAPY LLC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 430 E BLUE RIDGE BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64145-1422
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Country | US
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Telephone | 816-945-2956
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Fax | 816-942-6898
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Provider Business Mailing Address
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Address Line | 430 E BLUE RIDGE BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64145-1422
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Country | US
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Telephone | 816-945-2956
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Fax | 816-942-6898
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Authorized Official
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Title or Position | OWNER
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Name | PHILLIP WATTS HEWITT
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Credential | M.S., CCC-SLP
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Telephone | 816-945-2956
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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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