Provider Demographics
NPI:1952921504
Name:INNOVATIVE SPEECH-LANGUAGE THERAPY, LLC
Entity Type:Organization
Organization Name:INNOVATIVE SPEECH-LANGUAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WOJCIK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP/L
Authorized Official - Phone:708-528-8808
Mailing Address - Street 1:622 WATERMARK WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-4845
Mailing Address - Country:US
Mailing Address - Phone:708-528-8808
Mailing Address - Fax:844-813-6479
Practice Address - Street 1:622 WATERMARK WAY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-4845
Practice Address - Country:US
Practice Address - Phone:708-528-8808
Practice Address - Fax:844-813-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty