Provider Demographics
NPI:1518213990
Name:PRAESTOSPEECH SLP PLLC
Entity Type:Organization
Organization Name:PRAESTOSPEECH SLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:ARBORE
Authorized Official - Last Name:MAINARDI
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:917-270-6177
Mailing Address - Street 1:4714 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3838
Mailing Address - Country:US
Mailing Address - Phone:917-270-6177
Mailing Address - Fax:718-428-0506
Practice Address - Street 1:4714 UTOPIA PKWY
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3838
Practice Address - Country:US
Practice Address - Phone:917-270-6177
Practice Address - Fax:718-428-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty