Provider Demographics
NPI:1396510020
Name:THE LITTLE SOUND BOX SPEECH THERAPY PLLC
Entity type:Organization
Organization Name:THE LITTLE SOUND BOX SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KALLIOPI
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOUTZOUROULIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP/TSSLD
Authorized Official - Phone:718-419-5050
Mailing Address - Street 1:254 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8005
Mailing Address - Country:US
Mailing Address - Phone:718-419-5050
Mailing Address - Fax:
Practice Address - Street 1:254 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-8005
Practice Address - Country:US
Practice Address - Phone:718-419-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty