Provider Demographics
NPI:1083908461
Name:FLEISCHMAN, MARY R (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:R
Last Name:FLEISCHMAN
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 1:8715 HEBDON RD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14171-9501
Mailing Address - Country:US
Mailing Address - Phone:716-310-0062
Mailing Address - Fax:
Practice Address - Street 1:8715 HEBDON RD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14171-9501
Practice Address - Country:US
Practice Address - Phone:716-310-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006051-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist