Healthcare Provider Details

I. General information

NPI: 1326381484
Provider Name (Legal Business Name): THE SPEECH GARDEN, PEDIATRIC SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 WAVERLY AVE
BROOKLYN NY
11205-2403
US

IV. Provider business mailing address

92 BROOK HOLLOW DR
NEW WINDSOR NY
12553-8624
US

V. Phone/Fax

Practice location:
  • Phone: 845-541-9045
  • Fax:
Mailing address:
  • Phone: 845-541-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number205572
License Number StateNY

VIII. Authorized Official

Name: CHRISTINE GENNA
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S. CCC-SLP, TSSLD
Phone: 845-541-9045