Provider Demographics
NPI:1629514054
Name:PROGRESSIVE PATHWAYS, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE PATHWAYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BARANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-514-4474
Mailing Address - Street 1:28316 HUMMINGDALE CIR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1997
Mailing Address - Country:US
Mailing Address - Phone:248-514-4474
Mailing Address - Fax:
Practice Address - Street 1:41850 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1819
Practice Address - Country:US
Practice Address - Phone:248-514-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101001522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty