Provider Demographics
NPI:1316584402
Name:SPEECH WORKS
Entity Type:Organization
Organization Name:SPEECH WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:636-346-2219
Mailing Address - Street 1:8124 KNIGHTS CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6225
Mailing Address - Country:US
Mailing Address - Phone:636-346-2219
Mailing Address - Fax:
Practice Address - Street 1:8124 KNIGHTS CROSSING CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6225
Practice Address - Country:US
Practice Address - Phone:636-346-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty