Healthcare Provider Details

I. General information

NPI: 1235427287
Provider Name (Legal Business Name): MAGUIRE SPEECH AND LANGUAGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BEDFORD AVE
ROCKAWAY PT NY
11697-1805
US

IV. Provider business mailing address

119 BEDFORD AVE
ROCKAWAY PT NY
11697-1805
US

V. Phone/Fax

Practice location:
  • Phone: 917-648-5969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number017042
License Number StateNY

VIII. Authorized Official

Name: KERRY MAGUIRE
Title or Position: PRESIDENT
Credential: M.A., CCC-SLP
Phone: 917-648-5969