Provider Demographics
NPI:1255666293
Name:UPPER ARLINGTON SPEECH THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:UPPER ARLINGTON SPEECH THERAPY SERVICES, LLC
Other - Org Name:MARY LYNN GAY/UPPER ARLINGTON SPEECH THERAPY SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:614-204-5066
Mailing Address - Street 1:5020 REED RD
Mailing Address - Street 2:STE C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2581
Mailing Address - Country:US
Mailing Address - Phone:614-204-5066
Mailing Address - Fax:614-654-5993
Practice Address - Street 1:5020 REED RD
Practice Address - Street 2:STE C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2581
Practice Address - Country:US
Practice Address - Phone:614-204-5066
Practice Address - Fax:614-654-5993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP4241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9385831Medicare PIN