Provider Demographics
NPI:1265764500
Name:PHENIX SPEECH AND LANGUAGE SERVICES
Entity type:Organization
Organization Name:PHENIX SPEECH AND LANGUAGE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MEDCCC
Authorized Official - Phone:334-468-3032
Mailing Address - Street 1:703 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-5038
Mailing Address - Country:US
Mailing Address - Phone:334-448-5636
Mailing Address - Fax:334-448-5637
Practice Address - Street 1:703 13TH ST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5038
Practice Address - Country:US
Practice Address - Phone:334-448-5636
Practice Address - Fax:334-448-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3982235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty