Provider Demographics
NPI:1255197075
Name:SPEAK YOUR PATH SPEECH-LANGUAGE PATHOLOGY PLLC
Entity type:Organization
Organization Name:SPEAK YOUR PATH SPEECH-LANGUAGE PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CRISINA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:516-506-9937
Mailing Address - Street 1:135 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2426
Mailing Address - Country:US
Mailing Address - Phone:516-506-9937
Mailing Address - Fax:
Practice Address - Street 1:135 MADISON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-2426
Practice Address - Country:US
Practice Address - Phone:516-506-9937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty