Provider Demographics
NPI:1053025098
Name:TRANSFORM SPEECH THERAPY L.L.C.
Entity type:Organization
Organization Name:TRANSFORM SPEECH THERAPY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYU
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:734-834-9927
Mailing Address - Street 1:6790 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9720
Mailing Address - Country:US
Mailing Address - Phone:734-834-9927
Mailing Address - Fax:
Practice Address - Street 1:401 HALL ST SW STE 185D
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-6502
Practice Address - Country:US
Practice Address - Phone:734-834-9927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty