Provider Demographics
NPI:1043582265
Name:SISKAVICH, MONALEE MARY (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:MONALEE
Middle Name:MARY
Last Name:SISKAVICH
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 RIVER ST
Mailing Address - Street 2:BULLDOG LANE
Mailing Address - City:CHATEAUGAY
Mailing Address - State:NY
Mailing Address - Zip Code:12920-2002
Mailing Address - Country:US
Mailing Address - Phone:518-497-6611
Mailing Address - Fax:
Practice Address - Street 1:42 RIVER ST
Practice Address - Street 2:BULLDOG LANE
Practice Address - City:CHATEAUGAY
Practice Address - State:NY
Practice Address - Zip Code:12920-2002
Practice Address - Country:US
Practice Address - Phone:518-497-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009073-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist