Provider Demographics
NPI:1851724967
Name:SPEECH LANGUAGE LEADERS, LLC
Entity Type:Organization
Organization Name:SPEECH LANGUAGE LEADERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BODENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC, SLP
Authorized Official - Phone:732-865-5632
Mailing Address - Street 1:1509 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3918
Mailing Address - Country:US
Mailing Address - Phone:732-865-5632
Mailing Address - Fax:732-905-8212
Practice Address - Street 1:1509 NEWPORT DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3918
Practice Address - Country:US
Practice Address - Phone:732-865-5632
Practice Address - Fax:732-905-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00527500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty