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General NPI Number Information
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NPI Number | 1427395227
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPEECH-LANGUAGE SERVICES, LLC
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 316 E BROAD ST 2ND FLOOR
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City | WESTFIELD
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State | NJ
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Zip | 07090-2122
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Country | US
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Telephone | 908-232-5501
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Fax |
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Provider Business Mailing Address
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Address Line | 316 E BROAD ST 2ND FLOOR
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City | WESTFIELD
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State | NJ
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Zip | 07090-2122
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Country | US
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Telephone | 908-232-5501
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JACQUELINE SHANKLE
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Credential | MS CCC SLP
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Telephone | 908-232-5501
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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 | 41YS00421900
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License Number State | NJ
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