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General NPI Number Information
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NPI Number | 1447487889
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Entity Type | Organization
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Legal Business Name | FIRST STEP EARLY INTERVENTION SERVICES
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Dates
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Enumeration Date | 06/12/2009
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Last Update Date | 07/04/2009
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Provider Practice Location Address
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Address Line | 4563 RIDGE RD
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City | CANANDAIGUA
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State | NY
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Zip | 14424-9600
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Country | US
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Telephone | 585-259-5316
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Fax | 585-396-7547
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Provider Business Mailing Address
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Address Line | 4563 RIDGE RD
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City | CANANDAIGUA
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State | NY
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Zip | 14424-9600
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Country | US
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Telephone | 585-259-5316
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Fax | 585-396-7547
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MRS. LISA R. JOHNSON
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Credential | CCC-SLP
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Telephone | 585-259-5316
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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 | 008351
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License Number State | NY
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