Provider Demographics
NPI:1407991235
Name:SPEECH AND LEARN SLP, PLLC
Entity Type:Organization
Organization Name:SPEECH AND LEARN SLP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:914-457-9095
Mailing Address - Street 1:1 EXECUTIVE BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6822
Mailing Address - Country:US
Mailing Address - Phone:914-457-9095
Mailing Address - Fax:914-457-9332
Practice Address - Street 1:1 EXECUTIVE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6822
Practice Address - Country:US
Practice Address - Phone:914-457-9095
Practice Address - Fax:914-457-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014400-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty