Provider Demographics
NPI:1467159574
Name:MIRACLES IN MOTION SPEECH AND LANGUA
Entity Type:Organization
Organization Name:MIRACLES IN MOTION SPEECH AND LANGUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ LEAD SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JIHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:609-471-4186
Mailing Address - Street 1:685 S NEW HAMPSHIRE AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1384
Mailing Address - Country:US
Mailing Address - Phone:609-471-4186
Mailing Address - Fax:
Practice Address - Street 1:685 S NEW HAMPSHIRE AVE APT 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1384
Practice Address - Country:US
Practice Address - Phone:609-471-4186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty