Provider Demographics
NPI:1982028668
Name:ACHIEVE CENTER FOR THERAPY, PLLC
Entity Type:Organization
Organization Name:ACHIEVE CENTER FOR THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:479-222-6142
Mailing Address - Street 1:2900 OLD GREENWOOD RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4550
Mailing Address - Country:US
Mailing Address - Phone:479-222-6142
Mailing Address - Fax:479-222-6148
Practice Address - Street 1:2900 OLD GREENWOOD RD
Practice Address - Street 2:SUITE I
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4550
Practice Address - Country:US
Practice Address - Phone:479-222-6142
Practice Address - Fax:479-222-6148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2240235Z00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty