=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285927913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GROWING WORDS, SPEECH AND LANGUAGE THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2011
-----------------------------------------------------
Last Update Date | 05/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 GILBERT ST SUITE E,
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12816-2643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-796-8001
-----------------------------------------------------
Fax | 518-677-5651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 GILBERT ST SUITE E,
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12816-2643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-796-8001
-----------------------------------------------------
Fax | 518-677-5651
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. KETURAH K PERKINS-TREMBLEY
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 518-677-5651
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | 014635
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------