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Speech-Language-Pathologist Healthcare Directory
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1.
SLP Name / Credentials
(Required.)
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2.
Name of Facility
(Required.)
*
3.
Full Address
(Required.)
4.
Email Address
5.
Phone Number
6.
Practice Setting
Inpatient
Outpatient
SNF
Swing Bed
Home Health
Private Practice
Medical Clinic
Other (please specify)
7.
Treatment Modality
In-Person
Telehealth
8.
Patient type
Adult
Pediatric
9.
SLP Service Delivery Area(s)
Speech Production
Language
Cognition
Swallowing and Feeding
Voice and Resonance
Auditory Habilitation / Rehabilitation
Social Communication
Fluency
Communication Modalities
AAC
Other (Please Specify)
10.
Additional Certification / Services
Myofascial Release
Vital Stim / NMES
EMST
Oral Myofunctional Therapy
FEES
MBSS
Hearing Screening
Early Intervention
Other (Please Specify)
11.
Other specialization or specific populations served which are not listed above
12.
Additional Comments
