Healthcare Provider Details

I. General information

NPI: 1831237965
Provider Name (Legal Business Name): TIMOTHY OVERBECK M.S., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 CENTRAL AVE W123 THOMPSON HALL
FREDONIA NY
14063-1127
US

IV. Provider business mailing address

151 WILTON AVENUE
JAMESTOWN NY
14701
US

V. Phone/Fax

Practice location:
  • Phone: 716-673-3202
  • Fax: 716-673-3235
Mailing address:
  • Phone: 716-661-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number009515-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: