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General NPI Number Information
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NPI Number | 1003271446
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Entity Type | Organization
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Legal Business Name | RISE ABOVE SPEECH THERAPY PLLC
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 280 PARK AVE S APT. 19F
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City | NEW YORK
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State | NY
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Zip | 10010-6121
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Country | US
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Telephone | 917-626-2997
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Fax |
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Provider Business Mailing Address
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Address Line | 280 PARK AVE S APT. 19F
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City | NEW YORK
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State | NY
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Zip | 10010-6121
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Country | US
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Telephone | 917-626-2997
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MS. CANDICE TOUSSIE
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Credential | M.S. CCC-SLP
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Telephone | 917-626-2997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 016662
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License Number State | NY
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