Basic Information
| Provider Information | |||||||||
| NPI: | 1811261381 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPEECH THERAPY CENTER OF RICHMOND, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 HIDDEN VALLEY DRIVE | ||||||||
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| City: | RICHMOND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473745155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652776466 | ||||||||
| FaxNumber: | 7659977422 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 N 15TH ST | ||||||||
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| City: | RICHMOND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473743303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659776466 | ||||||||
| FaxNumber: | 7659977422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2012 | ||||||||
| LastUpdateDate: | 03/01/2012 | ||||||||
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| AuthorizedOfficialLastName: | SAGNA | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH-LANGUAGE PATHOLOGIST/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7652776466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A.,CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 22003806A | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.