Basic Information
| Provider Information | |||||||||
| NPI: | 1740550912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBERGER SPEECH THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 E MARKET ST STE B | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174022835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173647778 | ||||||||
| FaxNumber: | 7173820196 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 E MARKET ST STE B | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173647778 | ||||||||
| FaxNumber: | 7173820196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2012 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | HARBERGER | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7173647778 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.S., CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL007966 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1019931960001 | 05 | PA | MEDICAID |