Provider Demographics
NPI:1346660529
Name:ANASTACIA SPEECH CORP
Entity Type:Organization
Organization Name:ANASTACIA SPEECH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUN SOO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:MSED/CCC-SLP/TSHH
Authorized Official - Phone:718-279-0594
Mailing Address - Street 1:23205 56TH RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2010
Mailing Address - Country:US
Mailing Address - Phone:718-279-0594
Mailing Address - Fax:718-279-0594
Practice Address - Street 1:23205 56TH RD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2010
Practice Address - Country:US
Practice Address - Phone:718-279-0594
Practice Address - Fax:718-279-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-26
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018359-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health