Provider Demographics
NPI:1982363073
Name:SPEAK YOUR LEGACY
Entity Type:Organization
Organization Name:SPEAK YOUR LEGACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUPO
Authorized Official - Suffix:
Authorized Official - Credentials:ST
Authorized Official - Phone:631-624-6755
Mailing Address - Street 1:62 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4029
Mailing Address - Country:US
Mailing Address - Phone:631-624-6755
Mailing Address - Fax:
Practice Address - Street 1:62 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4029
Practice Address - Country:US
Practice Address - Phone:631-624-6755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONICA YVONNE LUPO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty