Provider Demographics
NPI:1144779711
Name:SHORELINE SPEECH THERAPY
Entity Type:Organization
Organization Name:SHORELINE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CCC-SLP
Authorized Official - Phone:203-350-9311
Mailing Address - Street 1:9 DEER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2151
Mailing Address - Country:US
Mailing Address - Phone:203-350-9311
Mailing Address - Fax:
Practice Address - Street 1:15 ORCHARD PARK RD
Practice Address - Street 2:SUITE 22
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2268
Practice Address - Country:US
Practice Address - Phone:203-350-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty