Provider Demographics
NPI:1598310500
Name:THERASPEAK
Entity Type:Organization
Organization Name:THERASPEAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GLASS BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:270-678-5417
Mailing Address - Street 1:327 AUTUMN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9699
Mailing Address - Country:US
Mailing Address - Phone:270-678-5417
Mailing Address - Fax:
Practice Address - Street 1:327 AUTUMN RIDGE RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-9699
Practice Address - Country:US
Practice Address - Phone:270-678-5417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency