Provider Demographics
NPI:1033862602
Name:SPEECH UNBOUND
Entity Type:Organization
Organization Name:SPEECH UNBOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PUVALOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:586-221-0705
Mailing Address - Street 1:36358 GARFIELD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1152
Mailing Address - Country:US
Mailing Address - Phone:586-221-0705
Mailing Address - Fax:833-427-1163
Practice Address - Street 1:30353 MANSE ST
Practice Address - Street 2:
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045-1872
Practice Address - Country:US
Practice Address - Phone:586-221-0705
Practice Address - Fax:833-427-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty