| NPI | 1811642739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEKELL SMITH Principal 385-321-4714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-02-18 |