Basic Information
| Provider Information | |||||||||
| NPI: | 1609126648 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRIPLETT | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | M.S. CCC-SLP, TSSLD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VILLANCE | ||||||||
| OtherFirstName: | NATASHA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 439 WEST MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859247207 | ||||||||
| FaxNumber: | 5859247049 | ||||||||
| Practice Location | |||||||||
| Address1: | 439 W. MAPLE AVE | ||||||||
| Address2: | PERKINS ELEMENTARY | ||||||||
| City: | NEWARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859247207 | ||||||||
| FaxNumber: | 5859247049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 11/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.