Provider Demographics
NPI:1508138637
Name:SPEECH PLAY AT WORK, SPEECH-LANGUAGE PATHOLOGY PLLC
Entity Type:Organization
Organization Name:SPEECH PLAY AT WORK, SPEECH-LANGUAGE PATHOLOGY PLLC
Other - Org Name:SPEECH PLAY@WORK, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:SPEECH THERAPIST/MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHILIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:347-559-0868
Mailing Address - Street 1:243 FRANKLIN AVE
Mailing Address - Street 2:UNIT #2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4403
Mailing Address - Country:US
Mailing Address - Phone:305-798-1316
Mailing Address - Fax:
Practice Address - Street 1:243 FRANKLIN AVE
Practice Address - Street 2:UNIT #2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-4403
Practice Address - Country:US
Practice Address - Phone:305-798-1316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017591-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)