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General NPI Number Information
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NPI Number | 1427508290
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Entity Type | Organization
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Legal Business Name | PEDIATRIC COMMUNICATION CENTER, LLC
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 1268 MAIN ST
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City | NEWINGTON
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State | CT
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Zip | 06111-3038
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Country | US
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Telephone | 860-216-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 1268 MAIN ST
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City | NEWINGTON
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State | CT
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Zip | 06111-3038
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Country | US
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Telephone | 860-216-1100
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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 | JENNIFER SAKOWICZ
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Credential | M.S., CCC-SLP
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Telephone | 860-216-1100
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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 | 004279
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License Number State | CT
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