Provider Demographics
NPI:1841801529
Name:OPEN DOOR SPEECH THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:OPEN DOOR SPEECH THERAPY SERVICES, LLC
Other - Org Name:THE OPEN DOOR SPEECH THERAPY SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:518-334-9546
Mailing Address - Street 1:PO BOX 761
Mailing Address - Street 2:
Mailing Address - City:COEYMANS
Mailing Address - State:NY
Mailing Address - Zip Code:12045-0761
Mailing Address - Country:US
Mailing Address - Phone:518-334-9546
Mailing Address - Fax:
Practice Address - Street 1:47 BLAISDELL AVE
Practice Address - Street 2:
Practice Address - City:COEYMANS
Practice Address - State:NY
Practice Address - Zip Code:12045-7702
Practice Address - Country:US
Practice Address - Phone:518-334-9546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty