Provider Demographics
NPI:1083700553
Name:TRINITY SPEECH LANGUAGE AND LEARNING CENTER, INC
Entity Type:Organization
Organization Name:TRINITY SPEECH LANGUAGE AND LEARNING CENTER, INC
Other - Org Name:TRINITY SPEECH LANGUAGE AND LEARNING CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC, SLP
Authorized Official - Phone:205-608-2999
Mailing Address - Street 1:600 MAIN STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071
Mailing Address - Country:US
Mailing Address - Phone:205-608-2999
Mailing Address - Fax:205-978-8332
Practice Address - Street 1:600 MAIN STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071
Practice Address - Country:US
Practice Address - Phone:205-608-2999
Practice Address - Fax:205-978-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1427001726Medicare UPIN