Provider Demographics
NPI:1881977338
Name:COMO PEDIATRIC COMMUNICATION CENTER LLC
Entity type:Organization
Organization Name:COMO PEDIATRIC COMMUNICATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:COMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-828-3800
Mailing Address - Street 1:5877 LIVERNOIS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-3100
Mailing Address - Country:US
Mailing Address - Phone:248-828-3800
Mailing Address - Fax:248-828-4226
Practice Address - Street 1:5877 LIVERNOIS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-3100
Practice Address - Country:US
Practice Address - Phone:248-828-3800
Practice Address - Fax:248-828-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01025610235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty