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General NPI Number Information
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NPI Number | 1851156111
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Entity Type | Organization
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Legal Business Name | CHAMPION SPEECH THERAPY LLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 2186 PENNSYLVANIA TER
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City | NORTH PORT
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State | FL
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Zip | 34291-6292
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Country | US
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Telephone | 941-202-3182
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Fax |
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Provider Business Mailing Address
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Address Line | 2186 PENNSYLVANIA TER
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City | NORTH PORT
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State | FL
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Zip | 34291-6292
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Country | US
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Telephone |
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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 | COURTNEY WELCH
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Credential |
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Telephone | 941-202-3182
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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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