Provider Demographics
NPI:1396567491
Name:WILLIAMSBURG SPEECH THERAPY, PLLC
Entity type:Organization
Organization Name:WILLIAMSBURG SPEECH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:GRETCHEN
Authorized Official - Last Name:BURNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, TSSLD
Authorized Official - Phone:917-819-5602
Mailing Address - Street 1:26 WEST ST APT 5P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6275
Mailing Address - Country:US
Mailing Address - Phone:917-819-5602
Mailing Address - Fax:
Practice Address - Street 1:26 WEST ST APT 5P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-6275
Practice Address - Country:US
Practice Address - Phone:917-819-5602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty