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General NPI Number Information
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NPI Number | 1699021592
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Entity Type | Organization
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Legal Business Name | SPEECH LANGUAGE PATHOLOGY IN MOTION, PLLC
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Dates
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Enumeration Date | 07/28/2012
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Last Update Date | 07/28/2012
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Provider Practice Location Address
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Address Line | 829 OLD NICHOLS RD
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City | ISLANDIA
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State | NY
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Zip | 11749-5004
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Country | US
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Telephone | 631-479-3393
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Fax | 631-479-3358
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Provider Business Mailing Address
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Address Line | 829 OLD NICHOLS RD
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City | ISLANDIA
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State | NY
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Zip | 11749-5004
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Country | US
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Telephone | 631-479-3393
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Fax | 631-479-3358
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Authorized Official
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Title or Position | OWNER, SPEECH PATHOLOGIST
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Name | MS. TINA M ROCCO
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Credential | M.A. CCC-SLP, HPCS
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Telephone | 631-479-3393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 018512
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License Number State | NY
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