Provider Demographics
NPI:1205235793
Name:MAIA C. KING, SPEECH-LANGUAGE PATHOLOGIST PLLC
Entity type:Organization
Organization Name:MAIA C. KING, SPEECH-LANGUAGE PATHOLOGIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:MAIA
Authorized Official - Middle Name:COURTNEY
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-579-9872
Mailing Address - Street 1:8845 81ST RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7841
Mailing Address - Country:US
Mailing Address - Phone:917-579-9872
Mailing Address - Fax:
Practice Address - Street 1:8845 81ST RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7841
Practice Address - Country:US
Practice Address - Phone:917-579-9872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty