Healthcare Provider Details

I. General information

NPI: 1649723727
Provider Name (Legal Business Name): SPEECH LANGUAGE THERAPY OF CENTRAL NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 ACME RD
FRANKFORT NY
13340-3504
US

IV. Provider business mailing address

12 CENTRAL PLZ
ILION NY
13357-1701
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-9368
  • Fax:
Mailing address:
  • Phone: 315-525-5275
  • Fax: 315-293-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: RENEE ENGLISH
Title or Position: SPEECH PATHOLOGIST
Credential:
Phone: 315-525-5275