Provider Demographics
NPI:1821368978
Name:BROOKFIELD SPEECH AND LANGUAGE, LLC
Entity Type:Organization
Organization Name:BROOKFIELD SPEECH AND LANGUAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER; SPEECH/LANGUAGE PATH
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CUNDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, TSHH
Authorized Official - Phone:203-740-0932
Mailing Address - Street 1:499 FEDERAL RD
Mailing Address - Street 2:UNIT 13
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2041
Mailing Address - Country:US
Mailing Address - Phone:203-740-0932
Mailing Address - Fax:203-740-2880
Practice Address - Street 1:499 FEDERAL RD
Practice Address - Street 2:UNIT 13
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2041
Practice Address - Country:US
Practice Address - Phone:203-740-0932
Practice Address - Fax:203-740-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty