Provider Demographics
NPI:1073766457
Name:DEGANGI, IRENE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:DEGANGI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:431 ELTINGVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2107
Mailing Address - Country:US
Mailing Address - Phone:718-877-9366
Mailing Address - Fax:
Practice Address - Street 1:431 ELTINGVILLE BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2107
Practice Address - Country:US
Practice Address - Phone:718-877-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist