Organization
SPEECH PATHOLOGY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER SAMORAJCZYK (BILLING/OFFICE)
(475) 239-5512
Entity
Organization
Contact information
Practice address
100 BEARD SAWMILL RD STE 282, SHELTON, CT 06484-6175
(475) 239-5512
(203) 888-0352
Mailing address
100 BEARD SAWMILL RD STE 282, SHELTON, CT 06484-6175
(475) 239-5512
(203) 888-0352
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639555881
NPI
CT
Enumeration date
07/16/2020
Last updated
08/12/2020
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