Provider Demographics
NPI:1467603886
Name:PROGRESSIVE SPEECH SERVICES, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE SPEECH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MYRVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:317-598-1483
Mailing Address - Street 1:12668 LARGO DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8188
Mailing Address - Country:US
Mailing Address - Phone:317-598-1483
Mailing Address - Fax:317-598-1483
Practice Address - Street 1:12668 LARGO DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-8188
Practice Address - Country:US
Practice Address - Phone:317-598-1483
Practice Address - Fax:317-598-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002720A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200716160 AOtherLPI (LEGACY PROVIDER IDENTIFIER