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General NPI Number Information
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NPI Number | 1942062047
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Entity Type | Organization
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Legal Business Name | EVOLVE SLP THERAPY SERVICES PLLC
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 2877 MEAD ST
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598
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Country | US
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Telephone | 914-417-1755
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Fax |
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Provider Business Mailing Address
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Address Line | 2877 MEAD ST
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598
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Country | US
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Telephone | 914-417-1755
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | HANNAH TAHHAN-JACKSON
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Credential | SLP
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Telephone | 914-417-1755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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