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General NPI Number Information
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NPI Number | 1407216856
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Entity Type | Organization
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Legal Business Name | MICHELE PASQUALE SPEECH LANGUAGE PATHOLOGIST PC
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Dates
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Enumeration Date | 02/27/2016
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Last Update Date | 02/27/2016
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Provider Practice Location Address
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Address Line | 240 SAINT LAWRENCE ST
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City | SAYVILLE
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State | NY
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Zip | 11782-2111
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Country | US
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Telephone | 631-244-0075
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Fax |
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Provider Business Mailing Address
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Address Line | 240 SAINT LAWRENCE ST
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City | SAYVILLE
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State | NY
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Zip | 11782-2111
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Country | US
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Telephone | 631-244-0075
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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. MICHELE PASQUALE
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Credential | MA CCC SLP
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Telephone | 6312440000754
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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 | 0131871
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License Number State | NY
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