Provider Demographics
NPI:1083202089
Name:CHANGING PHASES SPEECH THERAPY
Entity Type:Organization
Organization Name:CHANGING PHASES SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LEAD THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NWAKEGO
Authorized Official - Middle Name:I
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:757-898-0231
Mailing Address - Street 1:804 LANCASTER LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8820
Mailing Address - Country:US
Mailing Address - Phone:757-898-0231
Mailing Address - Fax:
Practice Address - Street 1:804 LANCASTER LN
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8820
Practice Address - Country:US
Practice Address - Phone:757-898-0231
Practice Address - Fax:757-898-0231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty