Provider Demographics
NPI:1336858505
Name:LEARN. EAT. TALK. SMILE. SPEECH THERAPY
Entity Type:Organization
Organization Name:LEARN. EAT. TALK. SMILE. SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGISTDIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LICARI
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:631-790-5282
Mailing Address - Street 1:385 ROUTE 109 UNIT 1329
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5834
Mailing Address - Country:US
Mailing Address - Phone:631-790-5282
Mailing Address - Fax:
Practice Address - Street 1:1545 13TH ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5834
Practice Address - Country:US
Practice Address - Phone:631-790-5282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty