Provider Demographics
NPI:1972736452
Name:SPEECH LANGUAGE THERAPEUTIC SERVICES PC
Entity type:Organization
Organization Name:SPEECH LANGUAGE THERAPEUTIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROZALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:YARUSSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:718-427-1724
Mailing Address - Street 1:223 PICCADILLY DOWNS
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:718-427-1724
Mailing Address - Fax:
Practice Address - Street 1:223 PICCADILLY DOWNS
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:718-427-1724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0181432355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty