Provider Demographics
NPI:1285400143
Name:THE THERAPY CLUBHOUSE
Entity type:Organization
Organization Name:THE THERAPY CLUBHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MHS CCC-SLP
Authorized Official - Phone:573-299-0363
Mailing Address - Street 1:3405 W TRUMAN BLVD STE 210B
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5861
Mailing Address - Country:US
Mailing Address - Phone:573-299-0363
Mailing Address - Fax:
Practice Address - Street 1:3405 W TRUMAN BLVD STE 210B
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5861
Practice Address - Country:US
Practice Address - Phone:573-299-0363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty