Provider Demographics
NPI:1417228131
Name:TMS TASHA MARTIN-STANFORD SPEECH THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:TMS TASHA MARTIN-STANFORD SPEECH THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTIN-STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC/SLP
Authorized Official - Phone:816-373-4841
Mailing Address - Street 1:4820 QUEEN RIDGE AVE
Mailing Address - Street 2:#732
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64136-1423
Mailing Address - Country:US
Mailing Address - Phone:816-373-4841
Mailing Address - Fax:816-373-4841
Practice Address - Street 1:4820 QUEEN RIDGE AVE
Practice Address - Street 2:#732
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64136-1423
Practice Address - Country:US
Practice Address - Phone:816-373-4841
Practice Address - Fax:816-373-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116968235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty