Provider Demographics
NPI:1093975625
Name:SEIDENFRAU, SALLY RENEE (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:RENEE
Last Name:SEIDENFRAU
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 TAPPAN RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1724
Mailing Address - Country:US
Mailing Address - Phone:201-767-3791
Mailing Address - Fax:
Practice Address - Street 1:350 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4909
Practice Address - Country:US
Practice Address - Phone:212-996-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008614235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist