Basic Information
| Provider Information | |||||||||
| NPI: | 1972117810 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRINITY SPEECH THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E COURT AVE STE 305 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503092057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154122811 | ||||||||
| FaxNumber: | 5152373979 | ||||||||
| Practice Location | |||||||||
| Address1: | 2729 CUTLEAF DR | ||||||||
| Address2: | |||||||||
| City: | APEX | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275399193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782356260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUCHANAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9782356260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
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.