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General NPI Number Information
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NPI Number | 1235952920
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Entity Type | Organization
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Legal Business Name | PORTVILLE SPEECH-LANGUAGE PATHOLOGY PLLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 70 S MAIN ST
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City | PORTVILLE
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State | NY
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Zip | 14770-9706
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Country | US
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Telephone | 716-244-0038
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Fax |
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Provider Business Mailing Address
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Address Line | 70 S MAIN ST
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City | PORTVILLE
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State | NY
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Zip | 14770-9706
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Country | US
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Telephone | 716-244-0038
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Fax |
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Authorized Official
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Title or Position | NYS LIC. MS CCC-SLP
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Name | CAROLINE J. PAINTER
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Credential |
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Telephone | 716-244-0038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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