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General NPI Number Information
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NPI Number | 1316393663
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Entity Type | Organization
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Legal Business Name | INTEGRATED SPEECH PATHOLOGY, LLC
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 786 MOUNTAIN BLVD STE 203B
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City | WATCHUNG
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State | NJ
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Zip | 07069-6268
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Country | US
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Telephone | 866-539-6685
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Fax |
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Provider Business Mailing Address
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Address Line | 26 SNEIDER RD
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City | WARREN
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State | NJ
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Zip | 07059-7042
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Country | US
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Telephone | 908-256-3575
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. DONNA SPILLMAN KENNEDY
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Credential | M.S.
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Telephone | 866-539-6685
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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 | 41YSO O1580
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License Number State | NJ
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