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General NPI Number Information
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NPI Number | 1457978371
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Entity Type | Organization
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Legal Business Name | SPEAKEASY SPEECH-LANGUAGE THERAPY
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 2 BRIER HILL COURT SUITE 210, BUILDING C
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 732-585-2728
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Fax |
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Provider Business Mailing Address
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Address Line | 2 BRIER HILL COURT SUITE 210, BUILDING C
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816
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Country | US
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Telephone | 732-585-2728
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST/OWNER
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Name | TANIA DOMINGUES
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Credential | MA
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Telephone | 732-585-2728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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