Provider Demographics
NPI:1639954712
Name:EXPRESSIVE PATHWAYS SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:EXPRESSIVE PATHWAYS SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST (OWNER)
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:619-952-3442
Mailing Address - Street 1:225 FOX LN
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5036
Mailing Address - Country:US
Mailing Address - Phone:619-952-3442
Mailing Address - Fax:
Practice Address - Street 1:225 FOX LN
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5036
Practice Address - Country:US
Practice Address - Phone:619-952-3442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty