Provider Demographics
NPI:1407075765
Name:THE SPEECH LANGUAGE READING CENTER, PLLC
Entity Type:Organization
Organization Name:THE SPEECH LANGUAGE READING CENTER, PLLC
Other - Org Name:ASSOCIATES IN COMMUNICATION THERAPIES, P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:DALTON
Authorized Official - Last Name:BURROUGHS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:423-877-5042
Mailing Address - Street 1:1200 MOUNTAIN CREEK RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1687
Mailing Address - Country:US
Mailing Address - Phone:423-877-5042
Mailing Address - Fax:423-877-5046
Practice Address - Street 1:1200 MOUNTAIN CREEK RD
Practice Address - Street 2:SUITE 380
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-1687
Practice Address - Country:US
Practice Address - Phone:423-877-5042
Practice Address - Fax:423-877-5046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP549235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440985Medicaid