Provider Demographics
NPI:1083734719
Name:RAZ, LOIS K (MA SLP)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:K
Last Name:RAZ
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3917
Mailing Address - Country:US
Mailing Address - Phone:718-727-4903
Mailing Address - Fax:718-761-4527
Practice Address - Street 1:1324 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3917
Practice Address - Country:US
Practice Address - Phone:718-727-4903
Practice Address - Fax:718-761-4527
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0015991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist