Provider Demographics
NPI:1790170637
Name:BEAUTIFUL MINDS SPEECH AND LANGUAGE SERVICES
Entity Type:Organization
Organization Name:BEAUTIFUL MINDS SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KEASHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BODRICK
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:347-234-0985
Mailing Address - Street 1:245 RUMSEY RD
Mailing Address - Street 2:8X
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4500
Mailing Address - Country:US
Mailing Address - Phone:347-234-0985
Mailing Address - Fax:
Practice Address - Street 1:245 RUMSEY RD
Practice Address - Street 2:8X
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4500
Practice Address - Country:US
Practice Address - Phone:347-234-0985
Practice Address - Fax:914-595-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23315-1251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services