Healthcare Provider Details

I. General information

NPI: 1205081700
Provider Name (Legal Business Name): MILESTONES IN SPEECH & LANGUAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 FOWLER LAKE RD
GHENT NY
12075-2706
US

IV. Provider business mailing address

302 FOWLER LAKE RD
GHENT NY
12075-2706
US

V. Phone/Fax

Practice location:
  • Phone: 518-265-5371
  • Fax: 518-392-1157
Mailing address:
  • Phone: 518-265-5371
  • Fax: 518-392-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number012626-1
License Number StateNY

VIII. Authorized Official

Name: MS. HOPE DESMONIE
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MSED, CCC-SLP
Phone: 518-265-5371