Provider Demographics
NPI:1881179026
Name:ON-SITE SWALLOWING DIAGNOSTICS
Entity type:Organization
Organization Name:ON-SITE SWALLOWING DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:RAIBON
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:901-661-5887
Mailing Address - Street 1:1331 UNION AVE STE 709
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7557
Mailing Address - Country:US
Mailing Address - Phone:901-661-5887
Mailing Address - Fax:
Practice Address - Street 1:1331 UNION AVE STE 709
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7557
Practice Address - Country:US
Practice Address - Phone:901-661-5887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty