MEDICARE: SPEECH PLACE INC

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	235Z00000X	Speech-Language Pathologist	019387-1	NY

General Provider Information

NPI Number	:	1619221116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH PLACE INC

Provider Business Mailing Address
First Line	:	1360 46TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1360 46TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2139
Country	:	US
Telephone Number	:	718-431-0310
Fax Number	:

Authorized Official
Title or Position	:	SPEECH AND LANGUAGE PATHOLOGIST
Name	:	TZVI FRIEDMAN
Credential	:	MS, CCC-SLP
Telephone Number	:	718-431-0310

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	10/06/2013

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Directions to “SPEECH PLACE INC ” Practice Location

Language	Start Address	Practice Location

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