Basic Information
| Provider Information | |||||||||
| NPI: | 1215515168 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WALL TO WALL SPEECH THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 N UNION AVE UNIT 578 | ||||||||
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| City: | LANSDOWNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190502574 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 24 VETERANS SQ | ||||||||
| Address2: | |||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190633155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024011121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2021 | ||||||||
| LastUpdateDate: | 03/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | STEVENSON | ||||||||
| AuthorizedOfficialFirstName: | VANESSA | ||||||||
| AuthorizedOfficialMiddleName: | KIMBERLY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3024011121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A., CCC-SLP | ||||||||
| NPICertificationDate: | 03/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.