Provider Demographics
NPI:1124758073
Name:BUCKEYE SPEECH PATH LLC
Entity type:Organization
Organization Name:BUCKEYE SPEECH PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIZLER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:440-334-9551
Mailing Address - Street 1:17512 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-8032
Mailing Address - Country:US
Mailing Address - Phone:440-334-9551
Mailing Address - Fax:
Practice Address - Street 1:11925 PEARL RD STE 202
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3343
Practice Address - Country:US
Practice Address - Phone:440-334-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty