Provider Demographics
NPI:1821380254
Name:CAPITAL REGION SPEECH & SWALLOWING(SLP), P.C.
Entity Type:Organization
Organization Name:CAPITAL REGION SPEECH & SWALLOWING(SLP), P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-KONYE
Authorized Official - Suffix:
Authorized Official - Credentials:MS SLP
Authorized Official - Phone:518-682-2799
Mailing Address - Street 1:634 PLANK RD STE 207
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4881
Mailing Address - Country:US
Mailing Address - Phone:518-682-2799
Mailing Address - Fax:
Practice Address - Street 1:634 PLANK RD STE 207
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4881
Practice Address - Country:US
Practice Address - Phone:518-682-2799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012904-1261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech