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General NPI Number Information
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NPI Number | 1558754234
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Entity Type | Organization
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Legal Business Name | GRACEFUL SPEECH, LLC
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 130 N KING ST
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City | ELMONT
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State | NY
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Zip | 11003-4229
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Country | US
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Telephone | 718-813-4234
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Fax | 516-216-1975
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Provider Business Mailing Address
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Address Line | 130 N KING ST
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City | ELMONT
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State | NY
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Zip | 11003-4229
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Country | US
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Telephone | 718-813-4234
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Fax | 516-216-1975
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. AISHA CATHERINE DEMOSTHENES
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Credential | SLP
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Telephone | 718-813-4234
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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 | 019729
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License Number State | NY
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