Healthcare Provider Details

I. General information

NPI: 1356253926
Provider Name (Legal Business Name): WAHL SPEECH-LANGUAGE THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MERRITTS RD
FARMINGDALE NY
11735-3262
US

IV. Provider business mailing address

418 BROADWAY # 11649
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 718-598-0206
  • Fax:
Mailing address:
  • Phone: 718-598-0206
  • 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: JAMIE WAHL
Title or Position: MEMBER-MANAGER
Credential: MA, CCC-SLP, TSSLD
Phone: 718-598-0206