Healthcare Provider Details

I. General information

NPI: 1487269288
Provider Name (Legal Business Name): SPEAK YOUR MIND SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 10/13/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BUCKLAND HILLS DR APT 14222
MANCHESTER CT
06042-8742
US

IV. Provider business mailing address

345 BUCKLAND HILLS DR APT 14222
MANCHESTER CT
06042-8742
US

V. Phone/Fax

Practice location:
  • Phone: 516-578-9733
  • Fax:
Mailing address:
  • Phone: 860-245-1446
  • 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: JESSICA P RUBINSTEIN
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA CCC-SLP
Phone: 860-245-1446