Provider Demographics
NPI:1699021592
Name:SPEECH LANGUAGE PATHOLOGY IN MOTION, PLLC
Entity Type:Organization
Organization Name:SPEECH LANGUAGE PATHOLOGY IN MOTION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP, HPCS
Authorized Official - Phone:631-479-3393
Mailing Address - Street 1:829 OLD NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5004
Mailing Address - Country:US
Mailing Address - Phone:631-479-3393
Mailing Address - Fax:631-479-3358
Practice Address - Street 1:829 OLD NICHOLS RD
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5004
Practice Address - Country:US
Practice Address - Phone:631-479-3393
Practice Address - Fax:631-479-3358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018512261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech