Provider Demographics
NPI:1801397310
Name:SPEECH THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:SPEECH THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:NICHOLLE
Authorized Official - Last Name:FOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:304-483-2689
Mailing Address - Street 1:329 SHORT RUN RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26133-8186
Mailing Address - Country:US
Mailing Address - Phone:304-483-2689
Mailing Address - Fax:304-440-3273
Practice Address - Street 1:329 SHORT RUN RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WV
Practice Address - Zip Code:26133-8186
Practice Address - Country:US
Practice Address - Phone:304-483-2689
Practice Address - Fax:304-440-3273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22839122261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech