Provider Demographics
NPI:1114289352
Name:SEAGULL VENTURES LLC
Entity Type:Organization
Organization Name:SEAGULL VENTURES LLC
Other - Org Name:SEAGULL SPEECH & LANGUAGE SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCCSLP
Authorized Official - Phone:203-947-5782
Mailing Address - Street 1:19 MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3740
Mailing Address - Country:US
Mailing Address - Phone:203-947-5782
Mailing Address - Fax:
Practice Address - Street 1:19 MEADOW RIDGE LN
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3740
Practice Address - Country:US
Practice Address - Phone:203-947-5782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty