=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487441093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BUILDING BLOCKS SPEECH AND LANGUAGE THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2025
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 CEDAR BRK
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14750-9693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-640-4417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2120 CEDAR BRK
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14750-9693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-640-4417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | TRINA JEAN PISKO
-----------------------------------------------------
Credential | M.S. CCC-SLP, TSSLD
-----------------------------------------------------
Telephone | 716-640-4417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------