Provider Demographics
NPI:1932506805
Name:WESTERN RESERVE SPEECH&LANGUAGE PARTNERS
Entity Type:Organization
Organization Name:WESTERN RESERVE SPEECH&LANGUAGE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:THEOFRASTOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC,SLP
Authorized Official - Phone:440-285-0775
Mailing Address - Street 1:100 SEVENTH AVE STE 255
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-7804
Mailing Address - Country:US
Mailing Address - Phone:440-285-0775
Mailing Address - Fax:440-940-9952
Practice Address - Street 1:100 SEVENTH AVE STE 255
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7804
Practice Address - Country:US
Practice Address - Phone:440-285-0775
Practice Address - Fax:440-940-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty