Provider Demographics
NPI:1598070385
Name:SPEECH & COUNSELING SERVICES OF BRYN MAWR, LLC.
Entity Type:Organization
Organization Name:SPEECH & COUNSELING SERVICES OF BRYN MAWR, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-745-0590
Mailing Address - Street 1:212 LEE CIR
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3726
Mailing Address - Country:US
Mailing Address - Phone:610-745-0590
Mailing Address - Fax:
Practice Address - Street 1:212 LEE CIR
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3726
Practice Address - Country:US
Practice Address - Phone:610-745-0590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007567235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty