Provider Demographics
NPI:1962818773
Name:MARSH SPEECH LANGUAGE PATHOLOGY, P.C.
Entity Type:Organization
Organization Name:MARSH SPEECH LANGUAGE PATHOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAVON
Authorized Official - Middle Name:L
Authorized Official - Last Name:ST. GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:516-223-2604
Mailing Address - Street 1:926 LORENZ AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2823
Mailing Address - Country:US
Mailing Address - Phone:516-223-2604
Mailing Address - Fax:
Practice Address - Street 1:926 LORENZ AVE
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2823
Practice Address - Country:US
Practice Address - Phone:516-223-2604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016133-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency