Provider Demographics
NPI:1457978371
Name:SPEAKEASY SPEECH-LANGUAGE THERAPY
Entity Type:Organization
Organization Name:SPEAKEASY SPEECH-LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:732-585-2728
Mailing Address - Street 1:2 BRIER HILL COURT
Mailing Address - Street 2:SUITE 210, BUILDING C
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-585-2728
Mailing Address - Fax:
Practice Address - Street 1:2 BRIER HILL COURT
Practice Address - Street 2:SUITE 210, BUILDING C
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-585-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty