Healthcare Provider Details

I. General information

NPI: 1477789055
Provider Name (Legal Business Name): RIVER VALLEY SPEECH AND LANGUAGE INTERVENTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 BOARDMAN RD
POUGHKEEPSIE NY
12603-4870
US

IV. Provider business mailing address

143 BOARDMAN RD
POUGHKEEPSIE NY
12603-4870
US

V. Phone/Fax

Practice location:
  • Phone: 845-462-6701
  • Fax: 845-462-2731
Mailing address:
  • Phone: 845-462-6701
  • Fax: 845-462-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KATHLEEN C PHILLIPS
Title or Position: MEMBER
Credential: MA
Phone: 845-462-6701