Provider Demographics
NPI:1679981385
Name:PECONIC SPEECH SERVICES, P.C.
Entity type:Organization
Organization Name:PECONIC SPEECH SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC/SLP, PC
Authorized Official - Phone:631-948-2822
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-0789
Mailing Address - Country:US
Mailing Address - Phone:631-948-2822
Mailing Address - Fax:631-880-7788
Practice Address - Street 1:305 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:CALVERTON
Practice Address - State:NY
Practice Address - Zip Code:11933
Practice Address - Country:US
Practice Address - Phone:631-948-2822
Practice Address - Fax:631-880-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty