Provider Demographics
NPI:1619598000
Name:COMMUNICATING OUR WAY SPEECH AND LANGUAGE PATHOLOGY OUTPATIENT SERVICE
Entity Type:Organization
Organization Name:COMMUNICATING OUR WAY SPEECH AND LANGUAGE PATHOLOGY OUTPATIENT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRESA
Authorized Official - Middle Name:KEYONNA
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:281-662-5107
Mailing Address - Street 1:2417 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:VIOLET
Mailing Address - State:LA
Mailing Address - Zip Code:70092-2962
Mailing Address - Country:US
Mailing Address - Phone:281-662-5107
Mailing Address - Fax:
Practice Address - Street 1:2417 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:VIOLET
Practice Address - State:LA
Practice Address - Zip Code:70092-2962
Practice Address - Country:US
Practice Address - Phone:281-662-5107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty