Provider Demographics
NPI:1083469779
Name:TOGETHER WE GROW SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:TOGETHER WE GROW SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIVIDUAL BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MIX
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:740-405-7568
Mailing Address - Street 1:3690 BALTIMORE SOMERSET RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046-9513
Mailing Address - Country:US
Mailing Address - Phone:740-405-7568
Mailing Address - Fax:
Practice Address - Street 1:3690 BALTIMORE SOMERSET RD NE
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046-9513
Practice Address - Country:US
Practice Address - Phone:740-405-7568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty