MEDICARE: IC SPEECH LANGUAGE PATHOLOGY P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1407431026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IC SPEECH LANGUAGE PATHOLOGY P.C.

Provider Business Mailing Address
First Line	:	2615 AVENUE W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 AVENUE W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5041
Country	:	US
Telephone Number	:	646-670-3093
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	INNESSA CONTE
Credential	:
Telephone Number	:	646-670-3093

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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Directions to “IC SPEECH LANGUAGE PATHOLOGY P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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