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General NPI Number Information
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NPI Number | 1811261381
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Entity Type | Organization
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Legal Business Name | SPEECH THERAPY CENTER OF RICHMOND, LLC
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 103 N 15TH ST
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City | RICHMOND
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State | IN
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Zip | 47374-3303
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Country | US
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Telephone | 765-977-6466
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Fax | 765-997-7422
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Provider Business Mailing Address
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Address Line | 801 HIDDEN VALLEY DRIVE
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City | RICHMOND
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State | IN
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Zip | 47374-5155
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Country | US
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Telephone | 765-277-6466
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Fax | 765-997-7422
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST/ OWNER
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Name | SUSAN J SAGNA
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Credential | M.A.,CCC-SLP
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Telephone | 765-277-6466
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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 | 22003806A
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License Number State | IN
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