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General NPI Number Information
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NPI Number | 1730420936
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Entity Type | Organization
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Legal Business Name | SPEECH PATHOLOGY ASSOCIATES INC
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 1810 E BELTLINE AVE SE DEVOS COMMUNICATION CENTER, 225A
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5951
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Country | US
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Telephone | 616-954-1810
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Fax |
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Provider Business Mailing Address
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Address Line | 3951 BRIDGESTONE DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-1378
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Country | US
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Telephone | 616-954-1810
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | PATRICIA R EDWARDS
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Credential | MS-CCC-SLP
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Telephone | 616-450-9668
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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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