Provider Demographics
NPI:1063767374
Name:TC SPEECH, LLC
Entity type:Organization
Organization Name:TC SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CLOUSE-NORD
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:941-416-0511
Mailing Address - Street 1:4696 COUNTRY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1855
Mailing Address - Country:US
Mailing Address - Phone:941-416-0511
Mailing Address - Fax:941-921-4129
Practice Address - Street 1:4696 COUNTRY MANOR DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1855
Practice Address - Country:US
Practice Address - Phone:941-416-0511
Practice Address - Fax:941-921-4129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8912235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty