Provider Demographics
NPI:1710570387
Name:FREEDOM OF SPEECH, SPEECH THERAPY
Entity Type:Organization
Organization Name:FREEDOM OF SPEECH, SPEECH THERAPY
Other - Org Name:FREEDOM OF SPEECH
Other - Org Type:Other Name
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:FLAX
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:443-562-9879
Mailing Address - Street 1:1919 MARKET ST UNIT 2001
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1945
Mailing Address - Country:US
Mailing Address - Phone:443-562-9879
Mailing Address - Fax:
Practice Address - Street 1:1919 MARKET ST UNIT 2001
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1945
Practice Address - Country:US
Practice Address - Phone:443-562-9879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech