Provider Demographics
NPI:1033364559
Name:GREENSPON WOHLLEBEN, DANIELLE (MA CCC/SLP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GREENSPON WOHLLEBEN
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:WOHLLEBEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:2126 PEMACO RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5538
Mailing Address - Country:US
Mailing Address - Phone:516-632-5119
Mailing Address - Fax:
Practice Address - Street 1:128 SHEPHERD ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2257
Practice Address - Country:US
Practice Address - Phone:516-255-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013446-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist