Provider Demographics
NPI:1073900593
Name:HARKINS-FUENTES, NANCY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:HARKINS-FUENTES
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 1:15900 RIVERSIDE DR W
Mailing Address - Street 2:2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1004
Mailing Address - Country:US
Mailing Address - Phone:917-733-7434
Mailing Address - Fax:
Practice Address - Street 1:15900 RIVERSIDE DR W
Practice Address - Street 2:2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1004
Practice Address - Country:US
Practice Address - Phone:917-733-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021116235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist