Provider Demographics
NPI:1760156723
Name:STREET SIMPLE THERAPY INC.
Entity Type:Organization
Organization Name:STREET SIMPLE THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE-ANN
Authorized Official - Middle Name:CECILE
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:801-867-3894
Mailing Address - Street 1:1370 N FAIRFIELD RD STE G
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2677
Mailing Address - Country:US
Mailing Address - Phone:937-210-4565
Mailing Address - Fax:
Practice Address - Street 1:1370 N FAIRFIELD RD STE G
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2677
Practice Address - Country:US
Practice Address - Phone:937-210-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty