Provider Demographics
NPI:1457802738
Name:MIDWEST SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:MIDWEST SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COFFARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-205-3401
Mailing Address - Street 1:142 EDISON DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-3269
Mailing Address - Country:US
Mailing Address - Phone:513-205-3401
Mailing Address - Fax:
Practice Address - Street 1:440 N VERITY PKWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2129
Practice Address - Country:US
Practice Address - Phone:513-205-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty