Healthcare Provider Details

I. General information

NPI: 1376286054
Provider Name (Legal Business Name): SHORT AND SPEECH THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 FRANKLIN AVE
EGG HARBOR TOWNSHIP NJ
08234-5426
US

IV. Provider business mailing address

308 FRANKLIN AVE
EGG HARBOR TOWNSHIP NJ
08234-5426
US

V. Phone/Fax

Practice location:
  • Phone: 856-906-8819
  • 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: MRS. AMANDA FLORY SHORT
Title or Position: OWNER
Credential: M.S, CCC-SLP
Phone: 856-906-8819