Basic Information
| Provider Information | |||||||||
| NPI: | 1851949044 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIMPLY SPEECH & LANGUAGE SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3272 | ||||||||
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| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486053272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897971400 | ||||||||
| FaxNumber: | 9897974077 | ||||||||
| Practice Location | |||||||||
| Address1: | 9453 KOCHVILLE RD | ||||||||
| Address2: | |||||||||
| City: | FREELAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486238623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898780630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2019 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 9898780630 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.