Provider Demographics
NPI:1740078427
Name:CALLIE SLP
Entity type:Organization
Organization Name:CALLIE SLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:RYAN MARIE
Authorized Official - Last Name:WALDREP
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP/L
Authorized Official - Phone:734-620-0583
Mailing Address - Street 1:31781 BOCK ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1440
Mailing Address - Country:US
Mailing Address - Phone:734-620-0583
Mailing Address - Fax:
Practice Address - Street 1:31781 BOCK ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-1440
Practice Address - Country:US
Practice Address - Phone:734-620-0583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty