Provider Demographics
NPI:1770910515
Name:INNOVATIONS SPEECH THERAPY LLC
Entity type:Organization
Organization Name:INNOVATIONS SPEECH THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CCC-SLP
Authorized Official - Phone:636-485-1432
Mailing Address - Street 1:105 CLOVERLEAF MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4190
Mailing Address - Country:US
Mailing Address - Phone:636-485-1432
Mailing Address - Fax:636-246-0302
Practice Address - Street 1:105 CLOVERLEAF MEADOWS CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4190
Practice Address - Country:US
Practice Address - Phone:636-485-1432
Practice Address - Fax:636-246-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty