Provider Demographics
NPI:1639504848
Name:FUN WITH SPEECH THERAPY
Entity Type:Organization
Organization Name:FUN WITH SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOMOLNAYA
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP/TSSLD
Authorized Official - Phone:347-210-0223
Mailing Address - Street 1:3871 SEDGWICK AVE
Mailing Address - Street 2:#2A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4422
Mailing Address - Country:US
Mailing Address - Phone:347-210-0223
Mailing Address - Fax:
Practice Address - Street 1:3871 SEDGWICK AVE
Practice Address - Street 2:#2A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4422
Practice Address - Country:US
Practice Address - Phone:347-210-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty