Provider Demographics
NPI:1164850632
Name:BRIDGING THE GAP SPEECH AND LANGUAGE SERVICES PLLC
Entity Type:Organization
Organization Name:BRIDGING THE GAP SPEECH AND LANGUAGE SERVICES PLLC
Other - Org Name:BTG SPEECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HILLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:917-703-2010
Mailing Address - Street 1:58 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-1726
Mailing Address - Country:US
Mailing Address - Phone:917-703-2010
Mailing Address - Fax:
Practice Address - Street 1:58 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-1726
Practice Address - Country:US
Practice Address - Phone:917-703-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015650252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency