Provider Demographics
NPI:1083081855
Name:SPEECH & LANGUAGE SOLUTION
Entity Type:Organization
Organization Name:SPEECH & LANGUAGE SOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP TSSLD
Authorized Official - Phone:347-405-3443
Mailing Address - Street 1:10809 FERN PL
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2623
Mailing Address - Country:US
Mailing Address - Phone:347-405-3443
Mailing Address - Fax:
Practice Address - Street 1:10809 FERN PL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2623
Practice Address - Country:US
Practice Address - Phone:347-405-3443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021434-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency