Provider Demographics
NPI:1588930283
Name:SPEECH PATHOLOGY SOLUTIONS, LLC
Entity type:Organization
Organization Name:SPEECH PATHOLOGY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANTANO
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-SLP
Authorized Official - Phone:908-216-1597
Mailing Address - Street 1:1064 S MAIN ST BLDG 2C
Mailing Address - Street 2:
Mailing Address - City:WEST CREEK
Mailing Address - State:NJ
Mailing Address - Zip Code:08092-2914
Mailing Address - Country:US
Mailing Address - Phone:908-216-1597
Mailing Address - Fax:609-488-2651
Practice Address - Street 1:1064 S MAIN ST BLDG 2C
Practice Address - Street 2:
Practice Address - City:WEST CREEK
Practice Address - State:NJ
Practice Address - Zip Code:08092-2914
Practice Address - Country:US
Practice Address - Phone:609-488-2650
Practice Address - Fax:609-488-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00479900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty