Provider Demographics
NPI:1407184682
Name:GARRISON CITY SPEECH & LANGUAGE SERVICES, PLLC
Entity Type:Organization
Organization Name:GARRISON CITY SPEECH & LANGUAGE SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR, SPEECH/LANGUAGE PAT
Authorized Official - Prefix:
Authorized Official - First Name:SHARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:603-842-4924
Mailing Address - Street 1:40 CHESTNUT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3335
Mailing Address - Country:US
Mailing Address - Phone:603-842-4924
Mailing Address - Fax:603-343-4951
Practice Address - Street 1:40 CHESTNUT ST STE 3
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3335
Practice Address - Country:US
Practice Address - Phone:603-842-4924
Practice Address - Fax:603-343-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3116168Medicaid