Provider Demographics
NPI:1205873023
Name:PARAGON SPEECH PATHOLOGY INC
Entity type:Organization
Organization Name:PARAGON SPEECH PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC SLP
Authorized Official - Phone:816-228-4310
Mailing Address - Street 1:1214 WOODS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-2620
Mailing Address - Country:US
Mailing Address - Phone:816-228-4310
Mailing Address - Fax:816-228-4365
Practice Address - Street 1:3421 NW JEFFERSON ST STE A
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8013
Practice Address - Country:US
Practice Address - Phone:816-228-4310
Practice Address - Fax:816-228-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty