Provider Demographics
NPI:1659904134
Name:DESIREE CAPPUCCIO
Entity Type:Organization
Organization Name:DESIREE CAPPUCCIO
Other - Org Name:FAIRMOUNT SPEECH AND SWALLOWING THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:609-892-2733
Mailing Address - Street 1:3470 TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1435
Mailing Address - Country:US
Mailing Address - Phone:609-892-2733
Mailing Address - Fax:
Practice Address - Street 1:3470 TILDEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1435
Practice Address - Country:US
Practice Address - Phone:609-892-2733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty