Healthcare Provider Details

I. General information

NPI: 1750851986
Provider Name (Legal Business Name): SPEECH OF MADISON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BOSTON POST RD
MADISON CT
06443-2131
US

IV. Provider business mailing address

26 OVERLOOK FARMS RD
KILLINGWORTH CT
06419-1337
US

V. Phone/Fax

Practice location:
  • Phone: 203-500-1347
  • Fax:
Mailing address:
  • Phone: 860-391-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARON LYNN MARCZEWSKI
Title or Position: OWNER/SPEECH-LANGUAGE PATHOLOGIST
Credential: MS, CCC-SLP
Phone: 203-500-1347