Provider Demographics
NPI:1316526205
Name:SPEAKING OF SPEECH AND LANGUAGE THERAPY LLC
Entity type:Organization
Organization Name:SPEAKING OF SPEECH AND LANGUAGE THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KENEDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GENESY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:601-906-1118
Mailing Address - Street 1:PO BOX 7771
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-0647
Mailing Address - Country:US
Mailing Address - Phone:602-456-7199
Mailing Address - Fax:602-742-2739
Practice Address - Street 1:12725 W INDIAN SCHOOL RD STE E
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9520
Practice Address - Country:US
Practice Address - Phone:602-456-7199
Practice Address - Fax:602-742-2739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty