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General NPI Number Information
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NPI Number | 1790403061
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Entity Type | Organization
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Legal Business Name | SPEECH PATHOLOGY SERVICES
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 1498 N BROADWAY ST
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City | GREENVILLE
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State | OH
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Zip | 45331-2454
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Country | US
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Telephone | 937-548-2317
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Fax |
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Provider Business Mailing Address
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Address Line | 1498 N BROADWAY ST
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City | GREENVILLE
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State | OH
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Zip | 45331-2454
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Country | US
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Telephone | 937-548-2317
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | LINDSEY ELIZABETH BLACK
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Credential | MA CCC-SLP
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Telephone | 937-608-2841
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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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