Provider Demographics
NPI:1093364325
Name:GLYNN, ZAKIYA L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ZAKIYA
Middle Name:L
Last Name:GLYNN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 E 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3311
Mailing Address - Country:US
Mailing Address - Phone:718-314-2089
Mailing Address - Fax:
Practice Address - Street 1:770 GROTE ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1007
Practice Address - Country:US
Practice Address - Phone:718-561-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14299009OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION