Provider Demographics
NPI:1003583774
Name:SPEECH GENIE THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:SPEECH GENIE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-370-0809
Mailing Address - Street 1:590 BLOOMFIELD AVE STE 376
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2510
Mailing Address - Country:US
Mailing Address - Phone:973-826-0595
Mailing Address - Fax:
Practice Address - Street 1:590 BLOOMFIELD AVE STE 376
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2510
Practice Address - Country:US
Practice Address - Phone:973-826-0595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGINA SMITH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-30
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty