Provider Demographics
NPI:1134436561
Name:SLC THERAPY
Entity type:Organization
Organization Name:SLC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANDRIA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:SEALS
Authorized Official - Suffix:
Authorized Official - Credentials:M,A, CCC-SLP
Authorized Official - Phone:866-752-0899
Mailing Address - Street 1:36500 FORD RD
Mailing Address - Street 2:#229
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3769
Mailing Address - Country:US
Mailing Address - Phone:866-752-0899
Mailing Address - Fax:203-604-0602
Practice Address - Street 1:36500 FORD RD
Practice Address - Street 2:#229
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3769
Practice Address - Country:US
Practice Address - Phone:866-752-0899
Practice Address - Fax:203-604-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty