Provider Demographics
NPI:1356177356
Name:SPEECH THERAPY SOURCE INC
Entity type:Organization
Organization Name:SPEECH THERAPY SOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALQUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:201-543-8524
Mailing Address - Street 1:227 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4011
Mailing Address - Country:US
Mailing Address - Phone:201-543-8524
Mailing Address - Fax:201-945-4546
Practice Address - Street 1:227 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4011
Practice Address - Country:US
Practice Address - Phone:201-543-8524
Practice Address - Fax:201-945-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty