Provider Demographics
NPI:1811261381
Name:SPEECH THERAPY CENTER OF RICHMOND, LLC
Entity type:Organization
Organization Name:SPEECH THERAPY CENTER OF RICHMOND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:765-277-6466
Mailing Address - Street 1:801 HIDDEN VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5155
Mailing Address - Country:US
Mailing Address - Phone:765-277-6466
Mailing Address - Fax:765-997-7422
Practice Address - Street 1:103 N 15TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3303
Practice Address - Country:US
Practice Address - Phone:765-977-6466
Practice Address - Fax:765-997-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003806A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty