Provider Demographics
NPI:1710494737
Name:SPEECH WORKS SPENCER COUNTY LLC
Entity Type:Organization
Organization Name:SPEECH WORKS SPENCER COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:COWANS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:812-549-6235
Mailing Address - Street 1:2740 W OLD STATE ROAD 45
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-8232
Mailing Address - Country:US
Mailing Address - Phone:812-549-6235
Mailing Address - Fax:
Practice Address - Street 1:2072 N COUNTY ROAD 700 W
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:IN
Practice Address - Zip Code:47634-9480
Practice Address - Country:US
Practice Address - Phone:812-359-4012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty