Provider Demographics
NPI:1760514616
Name:SPEECH AND LANGUAGE ASSOCIATES OF DAYTON, INC.
Entity Type:Organization
Organization Name:SPEECH AND LANGUAGE ASSOCIATES OF DAYTON, INC.
Other - Org Name:AUDIOLOGY & SPEECH ASSOCIATES OF DAYTON, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:513-532-3412
Mailing Address - Street 1:15 SOUTHMOOR CIR NE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2451
Mailing Address - Country:US
Mailing Address - Phone:937-886-4312
Mailing Address - Fax:937-293-0297
Practice Address - Street 1:15 SOUTHMOOR CIR NE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2451
Practice Address - Country:US
Practice Address - Phone:937-886-4312
Practice Address - Fax:937-293-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0420155Medicaid
OH0420155Medicaid