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Organization
EXPRESSION CONNECTION LLC
Active
Organization
EXPRESSION CONNECTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN C CUSTODIO CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST)
(929) 414-1234
Entity
Organization
Contact information
Practice address
376 KEAP ST APT 63, BROOKLYN, NY 11211-6363
(347) 658-3858
Mailing address
376 KEAP ST APT 63, BROOKLYN, NY 11211-6363
(347) 658-3858
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04574705
—
NY
Enumeration date
02/28/2020
Last updated
02/28/2020
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