Provider Demographics
NPI:1477789055
Name:RIVER VALLEY SPEECH AND LANGUAGE INTERVENTION SERVICES
Entity Type:Organization
Organization Name:RIVER VALLEY SPEECH AND LANGUAGE INTERVENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:845-462-6701
Mailing Address - Street 1:143 BOARDMAN RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-4870
Mailing Address - Country:US
Mailing Address - Phone:845-462-6701
Mailing Address - Fax:845-462-2731
Practice Address - Street 1:143 BOARDMAN RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-4870
Practice Address - Country:US
Practice Address - Phone:845-462-6701
Practice Address - Fax:845-462-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty