Provider Demographics
NPI:1114670742
Name:FREEDOM OF SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:FREEDOM OF SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:PONDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-465-0726
Mailing Address - Street 1:1371 YMCA DRIVE
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1953
Mailing Address - Country:US
Mailing Address - Phone:636-375-8109
Mailing Address - Fax:636-465-0747
Practice Address - Street 1:1371 YMCA DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2617
Practice Address - Country:US
Practice Address - Phone:636-465-0726
Practice Address - Fax:636-465-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500106232Medicaid