Provider Demographics
NPI:1376275909
Name:CREATING CHANGE THERAPY PLLC
Entity Type:Organization
Organization Name:CREATING CHANGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:501-764-7964
Mailing Address - Street 1:1308 OAK ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5339
Mailing Address - Country:US
Mailing Address - Phone:501-764-7964
Mailing Address - Fax:501-932-6379
Practice Address - Street 1:1308 OAK ST UNIT B
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5339
Practice Address - Country:US
Practice Address - Phone:501-764-7964
Practice Address - Fax:501-932-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty