Healthcare Provider Details

I. General information

NPI: 1821762444
Provider Name (Legal Business Name): SUFFIELD SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1486 MOUNTAIN RD
WEST SUFFIELD CT
06093-3306
US

IV. Provider business mailing address

134 PROSPECT ST
SUFFIELD CT
06078-2017
US

V. Phone/Fax

Practice location:
  • Phone: 860-292-0376
  • Fax:
Mailing address:
  • Phone: 860-539-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARY DRENZEK
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 860-292-0376