Provider Demographics
NPI: | 1851174809 |
---|---|
Name: | CONNECTED SPEECH THERAPY, PLLC |
Entity Type: | Organization |
Organization Name: | CONNECTED SPEECH THERAPY, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SPEECH LANGUAGE PATHOLOGIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STEELE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MA, CCC-SLP |
Authorized Official - Phone: | 817-739-4853 |
Mailing Address - Street 1: | 3841 WOSLEY DR |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT WORTH |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76133-2049 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 817-739-4853 |
Mailing Address - Fax: | 817-270-9037 |
Practice Address - Street 1: | 3841 WOSLEY DR |
Practice Address - Street 2: | |
Practice Address - City: | FORT WORTH |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76133-2049 |
Practice Address - Country: | US |
Practice Address - Phone: | 817-739-4853 |
Practice Address - Fax: | 817-270-9037 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-08-15 |
Last Update Date: | 2023-08-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty |