Provider Demographics
NPI:1144867268
Name:SPEECH DELIVERS LANGUAGE THERAPIES
Entity type:Organization
Organization Name:SPEECH DELIVERS LANGUAGE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:YASHARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:615-839-8670
Mailing Address - Street 1:110 SOUTHPORT RD APT 49
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-3866
Mailing Address - Country:US
Mailing Address - Phone:615-839-8670
Mailing Address - Fax:
Practice Address - Street 1:2375 E MAIN ST STE A202
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1400
Practice Address - Country:US
Practice Address - Phone:615-839-8670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1814Medicaid