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General NPI Number Information
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NPI Number | 1487019840
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Entity Type | Organization
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Legal Business Name | KB SPEECH & LANGUAGE THERAPY LLC
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 108 LENAPE TRAIL
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City | BRIELLE
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State | NJ
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Zip | 08730
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Country | US
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Telephone | 732-612-3912
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Fax |
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Provider Business Mailing Address
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Address Line | 108 LENAPE TRAIL
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City | BRIELLE
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State | NJ
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Zip | 08730
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Country | US
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Telephone | 732-612-3912
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MRS. KELLY BALDINO
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Credential | MA CCC SLP
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Telephone | 908-565-4001
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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 | 41YS00569800
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License Number State | NJ
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