Provider Demographics
NPI:1821762444
Name:SUFFIELD SPEECH THERAPY
Entity Type:Organization
Organization Name:SUFFIELD SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRENZEK
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:860-292-0376
Mailing Address - Street 1:134 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2017
Mailing Address - Country:US
Mailing Address - Phone:860-539-6695
Mailing Address - Fax:
Practice Address - Street 1:1486 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WEST SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06093-3306
Practice Address - Country:US
Practice Address - Phone:860-292-0376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty