Provider Demographics
NPI:1003192238
Name:SOLOVIEV, ANNA (TSSLD, MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:SOLOVIEV
Suffix:
Gender:F
Credentials:TSSLD, MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2813
Mailing Address - Country:US
Mailing Address - Phone:718-369-7603
Mailing Address - Fax:
Practice Address - Street 1:350 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2813
Practice Address - Country:US
Practice Address - Phone:718-369-7603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12097507OtherAMERICAN SPEECH-HEARING ASSOCIATION CERTIFICATE
NY019320OtherSPEECH LANGUAGE PATHOLOGIST LICENSE