Provider Demographics
NPI: | 1275924219 |
---|---|
Name: | SPEECH THERAPY SOLUTIONS, LLC |
Entity Type: | Organization |
Organization Name: | SPEECH THERAPY SOLUTIONS, LLC |
Other - Org Name: | REACH THERAPY SOLUTIONS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FULLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | SLPA |
Authorized Official - Phone: | 480-788-8353 |
Mailing Address - Street 1: | 3012 N 17TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85015-6112 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-788-8353 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3012 N 17TH AVE |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85015-6112 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-788-8353 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-02-12 |
Last Update Date: | 2015-02-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
224Z00000X, 225100000X, 225A00000X, 225X00000X, 225XF0002X, 231H00000X, 231HA2400X, 235Z00000X | ||
AZ | SLPA 8363 | 2355S0801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225A00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Music Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 231HA2400X | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | Group - Multi-Specialty |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |