Provider Demographics
NPI:1235952920
Name:PORTVILLE SPEECH-LANGUAGE PATHOLOGY PLLC
Entity type:Organization
Organization Name:PORTVILLE SPEECH-LANGUAGE PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NYS LIC. MS CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-244-0038
Mailing Address - Street 1:70 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14770-9706
Mailing Address - Country:US
Mailing Address - Phone:716-244-0038
Mailing Address - Fax:
Practice Address - Street 1:70 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14770-9706
Practice Address - Country:US
Practice Address - Phone:716-244-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech