Provider Demographics
NPI:1770359564
Name:SPEECH PATHWAYS, LLC
Entity type:Organization
Organization Name:SPEECH PATHWAYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WITTROCK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:712-210-4302
Mailing Address - Street 1:1831 QUINT AVE
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3566
Mailing Address - Country:US
Mailing Address - Phone:712-210-4302
Mailing Address - Fax:
Practice Address - Street 1:408 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2325
Practice Address - Country:US
Practice Address - Phone:712-210-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty