Provider Demographics
NPI:1992148316
Name:QUILT AUTISM AND SPEECH CENTER CORP
Entity type:Organization
Organization Name:QUILT AUTISM AND SPEECH CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST AND
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:ZACHS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:860-380-0774
Mailing Address - Street 1:27 CANTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092
Mailing Address - Country:US
Mailing Address - Phone:860-217-1434
Mailing Address - Fax:
Practice Address - Street 1:64 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019
Practice Address - Country:US
Practice Address - Phone:860-217-1434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty