Provider Demographics
NPI:1073928727
Name:GIRIN, INNA (SLP, TSSLD-B)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:GIRIN
Suffix:
Gender:F
Credentials:SLP, TSSLD-B
Other - Prefix:
Other - First Name:INNA
Other - Middle Name:
Other - Last Name:YUKHANANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10240 67TH RD
Mailing Address - Street 2:APT. 4P
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2663
Mailing Address - Country:US
Mailing Address - Phone:845-505-8357
Mailing Address - Fax:
Practice Address - Street 1:10240 67TH RD
Practice Address - Street 2:APT. 4P
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2663
Practice Address - Country:US
Practice Address - Phone:845-505-8357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist