Provider Demographics
NPI:1588027866
Name:INNOVATIVE SPEECH & SWALLOWING PARTNERS LLC
Entity Type:Organization
Organization Name:INNOVATIVE SPEECH & SWALLOWING PARTNERS LLC
Other - Org Name:INNOVATIVE THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIJO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:330-595-9059
Mailing Address - Street 1:11330 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8078
Mailing Address - Country:US
Mailing Address - Phone:330-595-9059
Mailing Address - Fax:330-595-1525
Practice Address - Street 1:11330 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8078
Practice Address - Country:US
Practice Address - Phone:330-595-9059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INNOVATIVE SPEECH & SWALLOWING PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-03
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty