Provider Demographics
NPI:1285408435
Name:FRESH START SPEECH THERAPY PLLC
Entity type:Organization
Organization Name:FRESH START SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MIRLAS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, TSSLD
Authorized Official - Phone:347-583-0304
Mailing Address - Street 1:1480 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5730
Mailing Address - Country:US
Mailing Address - Phone:347-583-0304
Mailing Address - Fax:
Practice Address - Street 1:1480 E 71ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5730
Practice Address - Country:US
Practice Address - Phone:347-583-0304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency