Provider Demographics
NPI:1508580986
Name:ELEVATE SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:ELEVATE SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERATH
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CCC- SLP
Authorized Official - Phone:815-354-7266
Mailing Address - Street 1:1920 E INDIAN SCHOOL RD APT 4006
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6064
Mailing Address - Country:US
Mailing Address - Phone:815-354-7266
Mailing Address - Fax:
Practice Address - Street 1:3101 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2419
Practice Address - Country:US
Practice Address - Phone:815-354-7266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty