Provider Demographics
NPI:1962158360
Name:MAXIMUM POTENTIAL SPEECH THERAPY SERVICES LLC
Entity type:Organization
Organization Name:MAXIMUM POTENTIAL SPEECH THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-581-2341
Mailing Address - Street 1:120 BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-2031
Mailing Address - Country:US
Mailing Address - Phone:251-581-2341
Mailing Address - Fax:
Practice Address - Street 1:120 BERNARD ST
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2031
Practice Address - Country:US
Practice Address - Phone:251-581-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty