Provider Demographics
NPI:1083981674
Name:IAK SPEECH THERAPY PC
Entity Type:Organization
Organization Name:IAK SPEECH THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVRUTIN-KHOTYLEV
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:917-541-0110
Mailing Address - Street 1:30 KANSAS PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6909
Mailing Address - Country:US
Mailing Address - Phone:917-541-0110
Mailing Address - Fax:
Practice Address - Street 1:30 KANSAS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6909
Practice Address - Country:US
Practice Address - Phone:917-541-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-26
Last Update Date:2011-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014692252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency