Provider Demographics
NPI:1356651822
Name:FK SPEECH LANGUAGE PATHOLOGY SERVICES
Entity Type:Organization
Organization Name:FK SPEECH LANGUAGE PATHOLOGY SERVICES
Other - Org Name:MILLENNIUM CHILDRENS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCCSLP
Authorized Official - Phone:631-421-3949
Mailing Address - Street 1:214 WALL STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:214 WALL STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-421-3949
Practice Address - Fax:631-421-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013764252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency