Provider Demographics
NPI:1992440648
Name:SMALL TOWN SPEECH THERAPY PLLC
Entity type:Organization
Organization Name:SMALL TOWN SPEECH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLZIN
Authorized Official - Suffix:
Authorized Official - Credentials:M S ED CCC/SLP
Authorized Official - Phone:716-575-5024
Mailing Address - Street 1:3283 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-9509
Mailing Address - Country:US
Mailing Address - Phone:518-307-5340
Mailing Address - Fax:
Practice Address - Street 1:3283 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057-9509
Practice Address - Country:US
Practice Address - Phone:518-307-5340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty