Healthcare Provider Details

I. General information

NPI: 1760390033
Provider Name (Legal Business Name): SEA TO SUMMIT SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MELINDA TER
DANIELSON CT
06239-1517
US

IV. Provider business mailing address

30 MELINDA TER
DANIELSON CT
06239-1517
US

V. Phone/Fax

Practice location:
  • Phone: 860-942-9619
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONICA PHONGSA
Title or Position: OWNER
Credential: CCC-SLP
Phone: 860-942-9619