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General NPI Number Information
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NPI Number | 1821380254
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Entity Type | Organization
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Legal Business Name | CAPITAL REGION SPEECH & SWALLOWING(SLP), P.C.
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 634 PLANK RD STE 207
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City | CLIFTON PARK
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State | NY
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Zip | 12065-4881
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Country | US
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Telephone | 518-682-2799
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Fax |
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Provider Business Mailing Address
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Address Line | 634 PLANK RD STE 207
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City | CLIFTON PARK
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State | NY
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Zip | 12065-4881
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Country | US
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Telephone | 518-682-2799
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. GLADYS SMITH-KONYE
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Credential | M.S. SLP
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Telephone | 518-682-2799
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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 | 012904-1
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License Number State | NY
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