Provider Demographics
NPI:1992400808
Name:HONEYSUCKLE PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:HONEYSUCKLE PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STASCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:678-654-7915
Mailing Address - Street 1:201 GILLESPIE DR APT 14402
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5732
Mailing Address - Country:US
Mailing Address - Phone:678-654-7915
Mailing Address - Fax:
Practice Address - Street 1:201 GILLESPIE DR APT 14402
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5732
Practice Address - Country:US
Practice Address - Phone:678-654-7915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
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
TN1962138941Medicaid