Provider Demographics
NPI:1831849710
Name:COMMUNITY THERAPY SPEECH-LANGUAGE PATHOLOGY
Entity type:Organization
Organization Name:COMMUNITY THERAPY SPEECH-LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:ENISE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, DRPH
Authorized Official - Phone:256-655-0267
Mailing Address - Street 1:100 WYATT CIR
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-5614
Mailing Address - Country:US
Mailing Address - Phone:256-655-0267
Mailing Address - Fax:
Practice Address - Street 1:100 WYATT CIR
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-5614
Practice Address - Country:US
Practice Address - Phone:256-655-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty