Provider Demographics
NPI:1649514530
Name:MID ATLANTIC SPEECH PATHOLOGY, INC
Entity type:Organization
Organization Name:MID ATLANTIC SPEECH PATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-239-2750
Mailing Address - Street 1:724 YORKLYN RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8704
Mailing Address - Country:US
Mailing Address - Phone:302-239-2750
Mailing Address - Fax:
Practice Address - Street 1:724 YORKLYN RD
Practice Address - Street 2:SUITE 260
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707
Practice Address - Country:US
Practice Address - Phone:302-239-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE300526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty