Provider Demographics
NPI:1457851180
Name:PITTSFORD SPEECH LANGUAGE THERAPY
Entity Type:Organization
Organization Name:PITTSFORD SPEECH LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:585-721-2556
Mailing Address - Street 1:30 OFFICE PARK WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-1734
Mailing Address - Country:US
Mailing Address - Phone:585-721-2556
Mailing Address - Fax:
Practice Address - Street 1:30 OFFICE PARK WAY
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1734
Practice Address - Country:US
Practice Address - Phone:585-419-7010
Practice Address - Fax:585-586-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021109-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty