Provider Demographics
NPI:1639415672
Name:EXPRESSIONS THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:EXPRESSIONS THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:KAUSHANSKY
Authorized Official - Last Name:CELENTANO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:201-815-9056
Mailing Address - Street 1:752 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2249
Mailing Address - Country:US
Mailing Address - Phone:201-815-9056
Mailing Address - Fax:
Practice Address - Street 1:752 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2249
Practice Address - Country:US
Practice Address - Phone:201-815-9056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00638900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty