Provider Demographics
NPI:1902038391
Name:CORNERSTONE SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:CORNERSTONE SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-973-9755
Mailing Address - Street 1:PO BOX 16092
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43216-6092
Mailing Address - Country:US
Mailing Address - Phone:614-973-9755
Mailing Address - Fax:
Practice Address - Street 1:7540 SAWMILL PKWY
Practice Address - Street 2:SUITE A-2
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9845
Practice Address - Country:US
Practice Address - Phone:614-973-9755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.7127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty