Provider Demographics
NPI:1710564257
Name:LAB SPEECH LANGUAGE
Entity Type:Organization
Organization Name:LAB SPEECH LANGUAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANCHETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MA SLP-CCC
Authorized Official - Phone:203-331-5412
Mailing Address - Street 1:261 VALENTINE RD
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-2116
Mailing Address - Country:US
Mailing Address - Phone:203-331-5421
Mailing Address - Fax:
Practice Address - Street 1:261 VALENTINE RD
Practice Address - Street 2:
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259-2116
Practice Address - Country:US
Practice Address - Phone:203-331-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech