Provider Demographics
NPI:1740027929
Name:SPEECH THERAPY PATHWAY
Entity type:Organization
Organization Name:SPEECH THERAPY PATHWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:LIA
Authorized Official - Last Name:HAQQ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-CCC
Authorized Official - Phone:813-385-4610
Mailing Address - Street 1:36750 US HIGHWAY 19 N UNIT 3229
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-1239
Mailing Address - Country:US
Mailing Address - Phone:813-385-4610
Mailing Address - Fax:
Practice Address - Street 1:36750 US HIGHWAY 19 N UNIT 3229
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1239
Practice Address - Country:US
Practice Address - Phone:813-385-4610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-13
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1285292805Medicaid