Organization Name: | SOUTH SHORE SPEECH LLC |
NPI Number: | 1003898123 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PEGGY M WRAY (SPEECH LANGUAGE PATHOLOGIST) |
Mailing Address: | 395 S Shore Dr Suite 310 Battle Creek |
State: | MI US |
Postal Code: | 490154466 |
Phone Number: | 2696601025 |
Fax Number: | 2696601588 |
NPI Enumeration Date: | 11/15/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |