Provider Demographics
NPI:1083842496
Name:HENRIQUEZ-GILLESPIE, DANNETTE MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANNETTE
Middle Name:MARIE
Last Name:HENRIQUEZ-GILLESPIE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8949 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6613
Mailing Address - Country:US
Mailing Address - Phone:718-261-1339
Mailing Address - Fax:
Practice Address - Street 1:8866 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7857
Practice Address - Country:US
Practice Address - Phone:718-850-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014053-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist