Provider Demographics
NPI:1982747366
Name:PEDIATRIC SPEECH, LANGUAGE, & LEARNING CENTER, LLC
Entity Type:Organization
Organization Name:PEDIATRIC SPEECH, LANGUAGE, & LEARNING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPEECH PATHOLOGY
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ROOT-LA FEMINA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:908-790-9555
Mailing Address - Street 1:230 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1171
Mailing Address - Country:US
Mailing Address - Phone:908-790-9555
Mailing Address - Fax:908-790-1133
Practice Address - Street 1:230 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1171
Practice Address - Country:US
Practice Address - Phone:908-790-9555
Practice Address - Fax:908-790-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4170103G00000X
NJYS3909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty