Provider Demographics
NPI:1669017620
Name:LOGOS SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:LOGOS SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:WATTS
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:816-945-2956
Mailing Address - Street 1:430 E BLUE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1422
Mailing Address - Country:US
Mailing Address - Phone:816-945-2956
Mailing Address - Fax:816-942-6898
Practice Address - Street 1:430 E BLUE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1422
Practice Address - Country:US
Practice Address - Phone:816-945-2956
Practice Address - Fax:816-942-6898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty