Provider Demographics
NPI:1750035564
Name:HAVEN SPEECH-LANGUAGE THERAPY PLLC
Entity Type:Organization
Organization Name:HAVEN SPEECH-LANGUAGE THERAPY PLLC
Other - Org Name:WEST SPEECH-LANGUAGE THERAPY PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC/SLP
Authorized Official - Phone:716-201-0893
Mailing Address - Street 1:1101 GREYMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9161
Mailing Address - Country:US
Mailing Address - Phone:716-201-0893
Mailing Address - Fax:
Practice Address - Street 1:1101 GREYMOOR WAY
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9161
Practice Address - Country:US
Practice Address - Phone:716-201-0893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty