Provider Demographics
NPI:1205885167
Name:SPEECH GEEK, LLC
Entity type:Organization
Organization Name:SPEECH GEEK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MEACHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:276-492-2069
Mailing Address - Street 1:851 FRENCH MOORE JR BLVD
Mailing Address - Street 2:SUITE 193
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-4738
Mailing Address - Country:US
Mailing Address - Phone:276-492-2069
Mailing Address - Fax:865-381-1275
Practice Address - Street 1:851 FRENCH MOORE JR BLVD
Practice Address - Street 2:SUITE 193
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-4738
Practice Address - Country:US
Practice Address - Phone:276-492-2069
Practice Address - Fax:865-381-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-6711Medicare ID - Type Unspecified