Organization
NURTURE & THRIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA EVANS CCC-SLP (ORGANIZER)
(786) 877-5679
Entity
Organization
Contact information
Practice address
1725 BOSTON ST SE, GRAND RAPIDS, MI 49506-4461
(786) 877-5679
Mailing address
1725 BOSTON ST SE, GRAND RAPIDS, MI 49506-4461
(786) 877-5679
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659435964
—
FL
Enumeration date
03/13/2024
Last updated
10/17/2024
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