Provider Demographics
NPI:1700445160
Name:SPEAKING-LISTENING-CONNECTING SPEECH-LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:SPEAKING-LISTENING-CONNECTING SPEECH-LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MCKENZIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:419-396-0105
Mailing Address - Street 1:103 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CAREY
Mailing Address - State:OH
Mailing Address - Zip Code:43316-1230
Mailing Address - Country:US
Mailing Address - Phone:419-396-0105
Mailing Address - Fax:419-396-0137
Practice Address - Street 1:103 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:CAREY
Practice Address - State:OH
Practice Address - Zip Code:43316-1230
Practice Address - Country:US
Practice Address - Phone:419-396-0105
Practice Address - Fax:419-396-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty