Provider Demographics
NPI:1770360570
Name:YOURSLPNY
Entity type:Organization
Organization Name:YOURSLPNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC
Authorized Official - Phone:347-889-1136
Mailing Address - Street 1:9210 SILVER RD
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2442
Mailing Address - Country:US
Mailing Address - Phone:347-889-1136
Mailing Address - Fax:
Practice Address - Street 1:9210 SILVER RD
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2442
Practice Address - Country:US
Practice Address - Phone:347-889-1136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty