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General NPI Number Information
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NPI Number | 1720357916
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Entity Type | Individual
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Provider Name | THERESA BLUMENTHAL CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 12/19/2011
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Provider Practice Location Address
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Address Line | 380 OLD TOWN ROAD
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City | E. SETAUKET
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State | NY
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Zip | 11733-3499
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Country | US
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Telephone | 631-730-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 14 CARDINAL LN
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2225
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Country | US
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Telephone | 631-265-2085
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 018705
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License Number State | NY
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