Provider Demographics
NPI:1891358800
Name:THE SPEECH AND LANGUAGE AGENCY LLC
Entity Type:Organization
Organization Name:THE SPEECH AND LANGUAGE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PARASCANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-974-2198
Mailing Address - Street 1:350 RICHMOND TER APT 3C
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1518
Mailing Address - Country:US
Mailing Address - Phone:917-974-2198
Mailing Address - Fax:
Practice Address - Street 1:350 RICHMOND TER APT 3C
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1518
Practice Address - Country:US
Practice Address - Phone:917-974-2198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY380422Medicaid