Provider Demographics
NPI:1114238060
Name:REDER, MICHELE (SLP/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:REDER
Suffix:
Gender:F
Credentials:SLP/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 BEACH 129TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1621
Mailing Address - Country:US
Mailing Address - Phone:718-474-0213
Mailing Address - Fax:718-474-0213
Practice Address - Street 1:253 BEACH 129TH ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1621
Practice Address - Country:US
Practice Address - Phone:718-474-0213
Practice Address - Fax:718-474-0213
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist