Provider Demographics
NPI:1962798975
Name:SLC THERAPY
Entity type:Organization
Organization Name:SLC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANDRIA
Authorized Official - Middle Name:SEALS
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:866-752-0899
Mailing Address - Street 1:36500 FORD ROAD
Mailing Address - Street 2:#229
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:866-752-0899
Mailing Address - Fax:203-604-0602
Practice Address - Street 1:29240 BUCKINGHAM SUITE 1
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:866-752-0899
Practice Address - Fax:203-604-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 235Z00000X, 251C00000X, 251S00000X
CT003069261QA3000X, 261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative CommunicationGroup - Single Specialty