Provider Demographics
NPI:1760178628
Name:SA SWALLOWING SERVICES PLLC
Entity Type:Organization
Organization Name:SA SWALLOWING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SKELLY
Authorized Official - Last Name:ASHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:SP
Authorized Official - Phone:629-221-0364
Mailing Address - Street 1:72 STONEBRIDGE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2158
Mailing Address - Country:US
Mailing Address - Phone:629-221-0364
Mailing Address - Fax:615-691-7133
Practice Address - Street 1:72 STONEBRIDGE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2158
Practice Address - Country:US
Practice Address - Phone:629-221-0364
Practice Address - Fax:615-691-7133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty