Provider Demographics
NPI:1841621927
Name:COVENANT SPEECH TX PLUS, LLC
Entity type:Organization
Organization Name:COVENANT SPEECH TX PLUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:FLUDD
Authorized Official - Suffix:
Authorized Official - Credentials:MPS
Authorized Official - Phone:757-715-0705
Mailing Address - Street 1:33 ST JOHNS DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4167
Mailing Address - Country:US
Mailing Address - Phone:757-715-0705
Mailing Address - Fax:757-838-2582
Practice Address - Street 1:33 ST JOHNS DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4167
Practice Address - Country:US
Practice Address - Phone:757-715-0705
Practice Address - Fax:757-838-2582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty