Provider Demographics
NPI:1760728109
Name:WHOLE CHILD SLP PC
Entity Type:Organization
Organization Name:WHOLE CHILD SLP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILANITH
Authorized Official - Middle Name:
Authorized Official - Last Name:REUVEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:917-796-7865
Mailing Address - Street 1:1038 BAY 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1802
Mailing Address - Country:US
Mailing Address - Phone:917-796-7865
Mailing Address - Fax:
Practice Address - Street 1:1038 BAY 24TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1802
Practice Address - Country:US
Practice Address - Phone:917-796-7865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty