Healthcare Provider Details

I. General information

NPI: 1962040790
Provider Name (Legal Business Name): SPEECH & LANGUAGE PALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 BEATRICE ST
TEANECK NJ
07666-2567
US

IV. Provider business mailing address

449 BEATRICE ST
TEANECK NJ
07666-2567
US

V. Phone/Fax

Practice location:
  • Phone: 201-707-9369
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. JOHN DACO
Title or Position: MEMBER
Credential: CCC-SLP
Phone: 201-707-9369