Provider Demographics
NPI:1770255382
Name:ISSA SPEECH THERAPY PLLC
Entity Type:Organization
Organization Name:ISSA SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AHLAM ISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:734-945-9628
Mailing Address - Street 1:2291 SHADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2291 SHADOWOOD DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2543
Practice Address - Country:US
Practice Address - Phone:734-945-9628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech