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General NPI Number Information
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NPI Number | 1215290549
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Entity Type | Organization
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Legal Business Name | INNOVATIVE SPEECH THERAPY INSTITUTE, P.L.L.C.
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 108 RIVERWAY PL BLDG 1
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City | BEDFORD
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State | NH
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Zip | 03110-6730
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Country | US
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Telephone | 603-318-6552
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Fax |
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Provider Business Mailing Address
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Address Line | 108 RIVERWAY PL BLDG 1
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City | BEDFORD
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State | NH
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Zip | 03110-6730
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Country | US
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Telephone | 603-318-6552
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Fax |
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Authorized Official
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Title or Position | MANAGER-SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. ALMA LUZ VELASQUEZ-ERMATINGER
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Credential | MS-CCC-SLP
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Telephone | 603-318-6552
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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 | 0980
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License Number State | NH
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