Provider Demographics
NPI:1962216945
Name:THRIVING ROOTS SPEECH THERAPY, LLC
Entity type:Organization
Organization Name:THRIVING ROOTS SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAN JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, QOM
Authorized Official - Phone:346-579-9054
Mailing Address - Street 1:1322 SPACE PARK DR STE C105D
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3557
Mailing Address - Country:US
Mailing Address - Phone:346-579-9054
Mailing Address - Fax:
Practice Address - Street 1:1322 SPACE PARK DR STE C105D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3557
Practice Address - Country:US
Practice Address - Phone:346-579-9054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty