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General NPI Number Information
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NPI Number | 1538679717
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Entity Type | Organization
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Legal Business Name | AT HOME SPEECH
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 11 TREEMAN DR UNIT 305
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-4747
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Country | US
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Telephone | 908-391-6012
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Fax |
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Provider Business Mailing Address
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Address Line | 11 TREEMAN DR UNIT 305
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-4747
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Country | US
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Telephone | 908-391-6012
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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 | WENDY LEAH NELSON
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Credential | CCC-SLP
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Telephone | 908-391-6012
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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 | 41YS00664600
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License Number State | NJ
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