Provider Demographics
NPI:1346851862
Name:MY SPEECH POCKET, LLC
Entity Type:Organization
Organization Name:MY SPEECH POCKET, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:MACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATHWOL
Authorized Official - Suffix:
Authorized Official - Credentials:MSED CCC-SLP
Authorized Official - Phone:804-390-5599
Mailing Address - Street 1:6155 DERBY WAY
Mailing Address - Street 2:
Mailing Address - City:RUTHER GLEN
Mailing Address - State:VA
Mailing Address - Zip Code:22546-2753
Mailing Address - Country:US
Mailing Address - Phone:804-390-5599
Mailing Address - Fax:
Practice Address - Street 1:6155 DERBY WAY
Practice Address - Street 2:
Practice Address - City:RUTHER GLEN
Practice Address - State:VA
Practice Address - Zip Code:22546-2753
Practice Address - Country:US
Practice Address - Phone:804-390-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty