Provider Demographics
NPI:1043970296
Name:LEARN & GROW PEDIATRIC THERAPY
Entity type:Organization
Organization Name:LEARN & GROW PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGY ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, BSED, SLP-A
Authorized Official - Phone:480-734-3566
Mailing Address - Street 1:2207 E CAROB DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2789
Mailing Address - Country:US
Mailing Address - Phone:480-352-3967
Mailing Address - Fax:
Practice Address - Street 1:2207 E CAROB DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2789
Practice Address - Country:US
Practice Address - Phone:480-352-3967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty