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Organization
INTREPID THERAPY PLLC
Active
Organization
INTREPID THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NERISSA SUKARUKOFF M.A. CCC-SLP (SPEECH LANGUAGE PATHOLOGIST/ OWNER)
(313) 410-0471
Entity
Organization
Contact information
Practice address
9274 STEEPHOLLOW DR, WHITE LAKE, MI 48386-2068
(313) 410-0471
Mailing address
9274 STEEPHOLLOW DR, WHITE LAKE, MI 48386-2068
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101004649
MI
Other
Enumeration date
06/08/2018
Last updated
06/08/2018
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