Provider Demographics
NPI:1386947158
Name:SPEECH & COMMUNICATION PROFESSIONAL SLP, AUDIOLOGY, PSYCHOLOGY, LMSW,
Entity type:Organization
Organization Name:SPEECH & COMMUNICATION PROFESSIONAL SLP, AUDIOLOGY, PSYCHOLOGY, LMSW,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:914-241-2727
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-0995
Mailing Address - Country:US
Mailing Address - Phone:914-241-2727
Mailing Address - Fax:914-243-9573
Practice Address - Street 1:1133 PLEASANTVILLE RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1634
Practice Address - Country:US
Practice Address - Phone:914-241-2727
Practice Address - Fax:914-243-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency