Provider Demographics
NPI:1164122529
Name:CONNECT TELEPRACTICE, LLC
Entity Type:Organization
Organization Name:CONNECT TELEPRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:631-901-3900
Mailing Address - Street 1:200 BRECKINGRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3951
Mailing Address - Country:US
Mailing Address - Phone:631-901-3900
Mailing Address - Fax:
Practice Address - Street 1:200 BRECKINGRIDGE DR
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3951
Practice Address - Country:US
Practice Address - Phone:631-901-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1831409549OtherNPI