Provider Demographics
NPI:1073825790
Name:SPEECH LANGUAGE PATHOLOGY, P.C.
Entity Type:Organization
Organization Name:SPEECH LANGUAGE PATHOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:COLBERT
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:914-594-4821
Mailing Address - Street 1:30 PLAZA W
Mailing Address - Street 2:NEW YORK MEDICAL COLLEGE
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-594-4912
Mailing Address - Fax:914-594-4853
Practice Address - Street 1:30 PLAZA W
Practice Address - Street 2:NEW YORK MEDICAL COLLEGE
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-594-4912
Practice Address - Fax:914-594-4853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty