Provider Demographics
NPI:1619556271
Name:ROCHESTER SPEECH LANGUAGE PATHOLOGY, PLLC
Entity Type:Organization
Organization Name:ROCHESTER SPEECH LANGUAGE PATHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:WEGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:585-355-7180
Mailing Address - Street 1:65 BENGAL TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2807
Mailing Address - Country:US
Mailing Address - Phone:585-355-7180
Mailing Address - Fax:
Practice Address - Street 1:65 BENGAL TER
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-2807
Practice Address - Country:US
Practice Address - Phone:585-355-7180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty