Provider Demographics
NPI:1073155040
Name:NATIONAL TELETHERAPY RESOURCES, A SPEECH PATHOLOGY CORP.
Entity Type:Organization
Organization Name:NATIONAL TELETHERAPY RESOURCES, A SPEECH PATHOLOGY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODERWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:844-687-5465
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-0058
Mailing Address - Country:US
Mailing Address - Phone:844-687-5465
Mailing Address - Fax:844-687-5465
Practice Address - Street 1:1001 22ND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606
Practice Address - Country:US
Practice Address - Phone:844-687-5465
Practice Address - Fax:844-687-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty