Provider Demographics
NPI:1750063673
Name:ESSENTIAL SPEECH THERAPY SOLUTIONS LLC
Entity type:Organization
Organization Name:ESSENTIAL SPEECH THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON KEETON
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:833-780-6334
Mailing Address - Street 1:11645 MONUMENT DR UNIT 1302
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1275
Mailing Address - Country:US
Mailing Address - Phone:941-780-6334
Mailing Address - Fax:
Practice Address - Street 1:11645 MONUMENT DR UNIT 1302
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-1275
Practice Address - Country:US
Practice Address - Phone:941-780-6334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty