Provider Demographics
NPI:1710541313
Name:PEDIATRIC ALLIED SPEECH SERVICES
Entity Type:Organization
Organization Name:PEDIATRIC ALLIED SPEECH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF THERAPY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SHELLY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:570-573-0065
Mailing Address - Street 1:815 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-1255
Mailing Address - Country:US
Mailing Address - Phone:570-573-0065
Mailing Address - Fax:
Practice Address - Street 1:815 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:MOHNTON
Practice Address - State:PA
Practice Address - Zip Code:19540-1255
Practice Address - Country:US
Practice Address - Phone:570-573-0065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency