Provider Demographics
NPI:1386915411
Name:SPEECHTASTIC THERAPIES
Entity type:Organization
Organization Name:SPEECHTASTIC THERAPIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROST
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:717-818-1165
Mailing Address - Street 1:2422 WEDGEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-9465
Mailing Address - Country:US
Mailing Address - Phone:717-818-1165
Mailing Address - Fax:904-239-3283
Practice Address - Street 1:2422 WEDGEWOOD WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-9465
Practice Address - Country:US
Practice Address - Phone:717-818-1165
Practice Address - Fax:904-239-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245400134Medicaid