=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194979518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHATTER TOTS SPEECH LANGUAGE PATHOLOGY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2008
-----------------------------------------------------
Last Update Date | 11/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56 DONCASTER RD
-----------------------------------------------------
City | MALVERNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11565-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-872-4186
-----------------------------------------------------
Fax | 516-872-4186
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 56 DONCASTER RD
-----------------------------------------------------
City | MALVERNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11565-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-872-4186
-----------------------------------------------------
Fax | 516-872-4186
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH PATHOLOGIST
-----------------------------------------------------
Name | MRS. ADRIENNE PERLAZA
-----------------------------------------------------
Credential | M.A. CCC/SLP
-----------------------------------------------------
Telephone | 516-872-4186
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 015182-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------