Provider Demographics
NPI:1043567621
Name:ADVANCED SPEECH-LANGUAGE SERVICES
Entity Type:Organization
Organization Name:ADVANCED SPEECH-LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-775-0386
Mailing Address - Street 1:673 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-9659
Mailing Address - Country:US
Mailing Address - Phone:517-775-0386
Mailing Address - Fax:
Practice Address - Street 1:673 WAVERLY RD
Practice Address - Street 2:
Practice Address - City:DIMONDALE
Practice Address - State:MI
Practice Address - Zip Code:48821-9659
Practice Address - Country:US
Practice Address - Phone:517-775-0386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty