Provider Demographics
NPI:1114180981
Name:CHILDREN'S THERAPY SPECIALISTS
Entity Type:Organization
Organization Name:CHILDREN'S THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DOMINICK
Authorized Official - Last Name:STAGNITTI
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:860-298-9079
Mailing Address - Street 1:601 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1325
Mailing Address - Country:US
Mailing Address - Phone:860-298-9079
Mailing Address - Fax:860-298-8413
Practice Address - Street 1:601 RIVER ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1325
Practice Address - Country:US
Practice Address - Phone:860-298-9079
Practice Address - Fax:860-298-8413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0081827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty