Provider Demographics
NPI:1629781844
Name:EARLY SPEECH PRO LLC
Entity Type:Organization
Organization Name:EARLY SPEECH PRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEEBA
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP, MS CCC
Authorized Official - Phone:845-206-8666
Mailing Address - Street 1:25 CATOCTIN CIR SE UNIT 4042
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3625
Mailing Address - Country:US
Mailing Address - Phone:703-261-9283
Mailing Address - Fax:
Practice Address - Street 1:25 CATOCTIN CIR SE UNIT 4042
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3625
Practice Address - Country:US
Practice Address - Phone:703-261-9283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty