MEDICARE: EVOLVE SLP THERAPY SERVICES PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	174N00000X	Lactation Consultant (Non-RN)
3	235Z00000X	Speech-Language Pathologist
4	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1942062047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE SLP THERAPY SERVICES PLLC

Provider Business Mailing Address
First Line	:	2877 MEAD ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598
Country	:	US
Telephone Number	:	914-417-1755
Fax Number	:

Provider Business Practice Location Address
First Line	:	2877 MEAD ST
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598
Country	:	US
Telephone Number	:	914-417-1755
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	HANNAH TAHHAN-JACKSON
Credential	:	SLP
Telephone Number	:	914-417-1755

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	04/22/2024

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