Provider Demographics
NPI:1134751605
Name:TOLEDO PEDIATRIC SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:TOLEDO PEDIATRIC SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:419-388-3523
Mailing Address - Street 1:PO BOX 8633
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-0633
Mailing Address - Country:US
Mailing Address - Phone:419-388-3523
Mailing Address - Fax:
Practice Address - Street 1:4430 N HOLLAND SYLVANIA RD APT 1132
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3542
Practice Address - Country:US
Practice Address - Phone:419-388-3523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty