Provider Demographics
NPI:1538679717
Name:AT HOME SPEECH
Entity Type:Organization
Organization Name:AT HOME SPEECH
Other - Org Name:AT HOME SPEECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:908-391-6012
Mailing Address - Street 1:11 TREEMAN DR UNIT 305
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4747
Mailing Address - Country:US
Mailing Address - Phone:908-391-6012
Mailing Address - Fax:
Practice Address - Street 1:11 TREEMAN DR UNIT 305
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4747
Practice Address - Country:US
Practice Address - Phone:908-391-6012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00664600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty