Provider Demographics
NPI:1780313767
Name:SPEAKEASY SPEECH THERAPY, PC
Entity type:Organization
Organization Name:SPEAKEASY SPEECH THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLAYE LACKRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-882-4583
Mailing Address - Street 1:399 MAIN AVE APT 315
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1568
Mailing Address - Country:US
Mailing Address - Phone:914-882-4583
Mailing Address - Fax:914-470-6200
Practice Address - Street 1:9 MOTT AVE STE 207 OFFICE 2
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3338
Practice Address - Country:US
Practice Address - Phone:203-293-7672
Practice Address - Fax:914-470-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency