=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154920676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLD SPRING SPEECH AND LANGUAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2020
-----------------------------------------------------
Last Update Date | 10/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 STONE ST
-----------------------------------------------------
City | COLD SPRING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10516-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-931-6607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 STONE ST
-----------------------------------------------------
City | COLD SPRING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10516-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-931-6607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SLP
-----------------------------------------------------
Name | ERIKA TROW
-----------------------------------------------------
Credential | SLP-CCC
-----------------------------------------------------
Telephone | 814-931-6607
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------