Provider Demographics
NPI:1114400843
Name:PEDIATRIC LANGUAGE CENTER
Entity Type:Organization
Organization Name:PEDIATRIC LANGUAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:AMIGO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:201-970-1080
Mailing Address - Street 1:2460 LEMOINE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6210
Mailing Address - Country:US
Mailing Address - Phone:201-331-6880
Mailing Address - Fax:201-944-0022
Practice Address - Street 1:2460 LEMOINE AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6210
Practice Address - Country:US
Practice Address - Phone:201-970-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-09
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty