Provider Demographics
NPI:1740857796
Name:ACTIVE SPEECH THERAPY PLLC
Entity type:Organization
Organization Name:ACTIVE SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GURPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-896-1209
Mailing Address - Street 1:480 N CANTON CENTER RD UNIT 871812
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-8773
Mailing Address - Country:US
Mailing Address - Phone:248-896-1209
Mailing Address - Fax:
Practice Address - Street 1:5840 N CANTON CENTER RD STE 224
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2684
Practice Address - Country:US
Practice Address - Phone:248-896-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty