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General NPI Number Information
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NPI Number | 1174669444
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Entity Type | Individual
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Provider Name | PERLA HALEGOUA M.A.,C.C.C.
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 1 CRESCENT RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1208
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Country | US
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Telephone | 631-928-6199
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CRESCENT RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1208
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Country | US
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Telephone | 631-928-6199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 001691-1
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License Number State | NY
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