Provider Demographics
NPI:1306616909
Name:27 EAST SPEECH-LANGUAGE THERAPY, PLLC
Entity type:Organization
Organization Name:27 EAST SPEECH-LANGUAGE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, TSSLD
Authorized Official - Phone:631-201-8870
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0207
Mailing Address - Country:US
Mailing Address - Phone:631-201-8870
Mailing Address - Fax:
Practice Address - Street 1:29 HICKORY BEND
Practice Address - Street 2:
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972
Practice Address - Country:US
Practice Address - Phone:631-201-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech