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General NPI Number Information
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NPI Number | 1982195566
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Entity Type | Organization
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Legal Business Name | YOUR PERSONAL SLP, LLC.
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Dates
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Enumeration Date | 05/19/2018
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Last Update Date | 05/19/2018
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Provider Practice Location Address
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Address Line | 95 S RIDGE LN
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City | BERLIN
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State | CT
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Zip | 06037
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Country | US
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Telephone | 860-785-4378
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 942
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City | ROCKY HILL
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State | CT
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Zip | 06067-0942
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Country | US
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Telephone | 860-785-4378
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Fax |
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Authorized Official
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Title or Position | OWNER/SPEECH-LANGUAGE PATHOLOGIST
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Name | MICHELLE AMENTA
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Credential | MS CCC-SLP
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Telephone | 860-785-4378
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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 | 003560
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License Number State | CT
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