Provider Demographics
NPI:1366251266
Name:CB SPEECH THERAPY LLC
Entity type:Organization
Organization Name:CB SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BEVACQUA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:201-373-6355
Mailing Address - Street 1:1826 WILLOW AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6623
Mailing Address - Country:US
Mailing Address - Phone:201-373-6355
Mailing Address - Fax:
Practice Address - Street 1:1826 WILLOW AVE APT 201
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-6623
Practice Address - Country:US
Practice Address - Phone:201-373-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty