Provider Demographics
NPI:1265074827
Name:THRIVE PEDIATRIC SPEECH AND FEEDING THERAPY, LLC
Entity type:Organization
Organization Name:THRIVE PEDIATRIC SPEECH AND FEEDING THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP, C/NDT
Authorized Official - Phone:989-370-3262
Mailing Address - Street 1:2855 44TH ST SW STE 160
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2682
Mailing Address - Country:US
Mailing Address - Phone:616-379-9887
Mailing Address - Fax:
Practice Address - Street 1:2855 44TH ST SW STE 160
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2682
Practice Address - Country:US
Practice Address - Phone:616-379-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty