Provider Demographics
NPI:1790145753
Name:SMALL WONDERS S.L.P,, P.C.
Entity Type:Organization
Organization Name:SMALL WONDERS S.L.P,, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SLP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:347-386-4961
Mailing Address - Street 1:18 VICTORIA TER
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2206
Mailing Address - Country:US
Mailing Address - Phone:347-389-4961
Mailing Address - Fax:
Practice Address - Street 1:18 VICTORIA TER
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2206
Practice Address - Country:US
Practice Address - Phone:347-389-4961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015159-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty