Healthcare Provider Details

I. General information

NPI: 1306424791
Provider Name (Legal Business Name): NEW PATTERN SPEECH THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PHENIX AVE
CRANSTON RI
02920-4233
US

IV. Provider business mailing address

67 PHENIX AVE
CRANSTON RI
02920-4233
US

V. Phone/Fax

Practice location:
  • Phone: 401-225-7717
  • Fax:
Mailing address:
  • Phone: 401-830-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TINA FOTINI MARSES
Title or Position: OWNER
Credential: MS, CCC-SLP
Phone: 401-830-2477