Healthcare Provider Details

I. General information

NPI: 1386812550
Provider Name (Legal Business Name): WESTERN NEW YORK SPEECH-LANGUAGE PATHOLOGY, OT, AND PT CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 FISHERS STATION DR SUITE 130
VICTOR NY
14564-9744
US

IV. Provider business mailing address

590 FISHERS STATION DR SUITE 130
VICTOR NY
14564-9744
US

V. Phone/Fax

Practice location:
  • Phone: 585-924-7207
  • Fax: 585-924-7049
Mailing address:
  • Phone: 585-924-7207
  • Fax: 585-924-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number002543-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number002543-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number002543-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LAURA A. FENN
Title or Position: DIRECTOR
Credential: M.A., CCC-SLP
Phone: 585-924-7207