=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013505502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALIE GARBER SPEECH THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2021
-----------------------------------------------------
Last Update Date | 01/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 253 LORETTO ST
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10307-1986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-463-0215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 LORETTO ST
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10307-1986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-463-0215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MS. HALIE LAUREN GARBER
-----------------------------------------------------
Credential | MA,CCC-SLP
-----------------------------------------------------
Telephone | 347-463-0215
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------