Provider Demographics
NPI:1235506726
Name:WIREGRASS THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WIREGRASS THERAPY ASSOCIATES, LLC
Other - Org Name:ADVANCED DYSPHAGIA SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/SPEECH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ORGERON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:334-446-1425
Mailing Address - Street 1:121 HIDDEN GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:334-446-1425
Mailing Address - Fax:334-647-6458
Practice Address - Street 1:121 HIDDEN GLEN WAY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-446-1425
Practice Address - Fax:334-647-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3251261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech