Provider Demographics
NPI:1194905208
Name:SHORELINE SPEECH & LANGUAGE CENTER
Entity type:Organization
Organization Name:SHORELINE SPEECH & LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH/LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:K
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-CLP
Authorized Official - Phone:832-545-3384
Mailing Address - Street 1:7 KERRIE CT
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1115
Mailing Address - Country:US
Mailing Address - Phone:832-545-3384
Mailing Address - Fax:
Practice Address - Street 1:7 KERRIE CT
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1115
Practice Address - Country:US
Practice Address - Phone:832-545-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty