Healthcare Provider Details

I. General information

NPI: 1750035564
Provider Name (Legal Business Name): HAVEN SPEECH-LANGUAGE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 PARK ST STE 201
FULTON NY
13069-2506
US

IV. Provider business mailing address

11468 CALKINS RD
CATO NY
13033-9726
US

V. Phone/Fax

Practice location:
  • Phone: 315-591-0462
  • Fax:
Mailing address:
  • Phone: 315-591-0462
  • 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: CHRISTINA MARIE PETERS
Title or Position: OWNER
Credential: MS-CCC/SLP
Phone: 585-297-7878