Organization
LILY PEARL SPEECH THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNAH MARGARET EDGAR MA, CCC-SLP (OWNER)
(812) 322-0052
Entity
Organization
Contact information
Practice address
824 W 4TH ST, BLOOMINGTON, IN 47404-5012
(812) 322-0052
Mailing address
824 W. 4TH ST., BLOOMINGTON, IN 47404
(812) 322-0052
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22005087A
IN
Other
Enumeration date
07/12/2013
Last updated
07/12/2013
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