Provider Demographics
NPI:1336757921
Name:LI SPEECH THERAPY OF SOUTH SHORE
Entity Type:Organization
Organization Name:LI SPEECH THERAPY OF SOUTH SHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOIST
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIENE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:631-689-6858
Mailing Address - Street 1:213 HALLOCK RD STE 6
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3000
Mailing Address - Country:US
Mailing Address - Phone:631-689-6858
Mailing Address - Fax:631-751-6027
Practice Address - Street 1:2915 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2716
Practice Address - Country:US
Practice Address - Phone:631-689-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty