Provider Demographics
NPI:1689072126
Name:TEEN TALK
Entity Type:Organization
Organization Name:TEEN TALK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:732-874-4374
Mailing Address - Street 1:128 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4211
Mailing Address - Country:US
Mailing Address - Phone:732-534-7094
Mailing Address - Fax:732-901-8899
Practice Address - Street 1:128 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4211
Practice Address - Country:US
Practice Address - Phone:732-534-7094
Practice Address - Fax:732-901-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty