Provider Demographics
NPI:1003319294
Name:SPEECH THERAPY ON THE GO LLC
Entity Type:Organization
Organization Name:SPEECH THERAPY ON THE GO LLC
Other - Org Name:AMANDA FOUTCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:FOUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:954-540-4808
Mailing Address - Street 1:4482 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-9189
Mailing Address - Country:US
Mailing Address - Phone:954-540-4808
Mailing Address - Fax:888-232-1831
Practice Address - Street 1:4482 FORD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-9189
Practice Address - Country:US
Practice Address - Phone:954-540-4808
Practice Address - Fax:888-232-1831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty