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Organization
MID-ISLAND SPEECH LANGUAGE PATHOLOGY, PLLC
Active
Organization
MID-ISLAND SPEECH LANGUAGE PATHOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACLYN HAVLICEK MA, CCC-SLP (SPEECH PATHOLOGIST, OWNER)
(631) 387-1926
Entity
Organization
Contact information
Practice address
24 DONALD STREET, HOLBROOK, NY 11741
(631) 387-1926
Mailing address
24 DONALD STREET, HOLBROOK, NY 11741
(631) 387-1926
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
108418
NY
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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