Provider Demographics
NPI:1265086615
Name:SIMPLY SPEAKING SPEECH PATHOLOGY, PLLC
Entity type:Organization
Organization Name:SIMPLY SPEAKING SPEECH PATHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:231-714-5034
Mailing Address - Street 1:771 S WEST SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-8530
Mailing Address - Country:US
Mailing Address - Phone:989-329-0431
Mailing Address - Fax:
Practice Address - Street 1:771 S WEST SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-8530
Practice Address - Country:US
Practice Address - Phone:231-714-5034
Practice Address - Fax:231-714-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty