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General NPI Number Information
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NPI Number | 1386972958
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Entity Type | Organization
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Legal Business Name | FINGERLAKESSPEECH-LANGUAGEPATHOLOG&PHYSICALTHEROPYSERVICES,PLLC
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 27 TALL OAKS DR
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City | SENECA FALLS
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State | NY
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Zip | 13148-1133
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Country | US
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Telephone | 315-568-2570
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Fax | 315-568-2570
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Provider Business Mailing Address
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Address Line | 27 TALL OAKS DR P.O. BOX 477
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City | SENECA FALLS
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State | NY
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Zip | 13148-1133
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Country | US
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Telephone | 315-568-2570
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Fax | 315-568-2570
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VIRGINIA ANN DEJOHN
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Credential |
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Telephone | 315-568-2570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 008177
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License Number State | NY
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