Provider Demographics
NPI:1336971183
Name:HARBOR SPEECH GROUP
Entity type:Organization
Organization Name:HARBOR SPEECH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUIA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:631-513-8871
Mailing Address - Street 1:79 MAIN ST STE 312
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2938
Mailing Address - Country:US
Mailing Address - Phone:516-717-0495
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST STE 312
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2938
Practice Address - Country:US
Practice Address - Phone:516-717-0495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty