MEDICARE: INTREPID THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7101004649	MI

General Provider Information

NPI Number	:	1912490525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTREPID THERAPY PLLC

Provider Business Mailing Address
First Line	:	9274 STEEPHOLLOW DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9274 STEEPHOLLOW DR
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2068
Country	:	US
Telephone Number	:	313-410-0471
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST/ OWNER
Name	:	NERISSA SUKARUKOFF
Credential	:	M.A. CCC-SLP
Telephone Number	:	313-410-0471

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	06/08/2018

Similar Medicare Providers

1992823496 — MS. DAWN MARIE BABLER MA LPC
Practice Location Address:

3 WHITE STREET , SUITE 2
RED BANK, NJ
07701-2068

Practice Phone: 732-933-1555
Practice Fax: 732-933-1557

1225206311 — ACCURATE HEARING CLINICS & AUDIOLOGY
Practice Location Address:

505 E 200 S STE 302
SALT LAKE CITY, UT
84102-2068

Practice Phone: 801-355-4327
Practice Fax: 801-355-4337

1649510363 — BRANDIE MICHELLE JAMES
Practice Location Address:

6800 E LAKE MEAD BLVD , UNIT #2068
LAS VEGAS, NV
89156-1119

Practice Phone: 702-253-0130
Practice Fax:

1174916571 — MELISSA WANSERSKI
Practice Location Address:

2795 E KENTON DR
SALT LAKE CITY, UT
84109-2068

Practice Phone: 715-432-9211
Practice Fax:

1518478742 — LCR DENTAL SUGAR HOUSE
Practice Location Address:

2068 S 2100 E SUITE #A
SALT LAKE CITY, UT
84108

Practice Phone: 801-532-1402
Practice Fax:

1346231370 — JODY TENJERAS DC
Practice Location Address:

10635 HIGHLAND ROAD
WHITE LAKE, MI
48386-3169

Practice Phone: 248-698-8677
Practice Fax: 248-698-8645

Directions to “INTREPID THERAPY PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.