Provider Demographics
NPI:1770831877
Name:METTOWEE VALLEY SPEECH THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:METTOWEE VALLEY SPEECH THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:518-642-3942
Mailing Address - Street 1:88 METTOWEE ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-4826
Mailing Address - Country:US
Mailing Address - Phone:518-642-3942
Mailing Address - Fax:518-642-3768
Practice Address - Street 1:88 METTOWEE ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-4826
Practice Address - Country:US
Practice Address - Phone:518-642-3942
Practice Address - Fax:518-642-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006966-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty