Provider Demographics
NPI:1003185638
Name:ZUCKERMAN, ROANNE (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROANNE
Middle Name:
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 WESTCHESTER AVENUE
Mailing Address - Street 2:SUITE 1A-B
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-939-6400
Mailing Address - Fax:914-939-6412
Practice Address - Street 1:388 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE 1A-B
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573
Practice Address - Country:US
Practice Address - Phone:914-939-6400
Practice Address - Fax:914-939-6412
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008773251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)