Provider Demographics
NPI:1417499385
Name:J. GUDIS SPEECH AND LANGUAGE
Entity Type:Organization
Organization Name:J. GUDIS SPEECH AND LANGUAGE
Other - Org Name:J. GUDIS SPEECH AND LANGUAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-833-7863
Mailing Address - Street 1:104 E 31ST ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6828
Mailing Address - Country:US
Mailing Address - Phone:323-833-7863
Mailing Address - Fax:
Practice Address - Street 1:104 E 31ST ST APT 5D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6828
Practice Address - Country:US
Practice Address - Phone:323-833-7863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities