Provider Demographics
NPI:1326381484
Name:THE SPEECH GARDEN, PEDIATRIC SPEECH THERAPY
Entity Type:Organization
Organization Name:THE SPEECH GARDEN, PEDIATRIC SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENNA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, TSSLD
Authorized Official - Phone:845-541-9045
Mailing Address - Street 1:92 BROOK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8624
Mailing Address - Country:US
Mailing Address - Phone:845-541-9045
Mailing Address - Fax:
Practice Address - Street 1:143 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2403
Practice Address - Country:US
Practice Address - Phone:845-541-9045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
NY205572252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency