Organization
SPEECH PATHOLOGY ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA R EDWARDS MS-CCC-SLP (AUTHORIZED OFFICIAL)
(616) 450-9668
Entity
Organization
Contact information
Practice address
1810 E BELTLINE AVE SE, DEVOS COMMUNICATION CENTER, 225A, GRAND RAPIDS, MI 49546-5951
(616) 954-1810
Mailing address
3951 BRIDGESTONE DR NE, GRAND RAPIDS, MI 49546-1378
(616) 954-1810
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00972133
ASHA CERTIFICATION
MI
Enumeration date
03/13/2013
Last updated
03/13/2013
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