Provider Demographics
NPI:1760735252
Name:MY SPOT FOR KIDS SPEECH LANGUAGE PATHOLOGY PLLC
Entity Type:Organization
Organization Name:MY SPOT FOR KIDS SPEECH LANGUAGE PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER SPEECH LANGUAGE PATHOLOGIS
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVULUNOV
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:656-756-4828
Mailing Address - Street 1:167 W 81ST ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7221
Mailing Address - Country:US
Mailing Address - Phone:646-756-4828
Mailing Address - Fax:
Practice Address - Street 1:167 W 81ST ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-7221
Practice Address - Country:US
Practice Address - Phone:646-756-4828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020882235Z00000X
NY0205841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty