Provider Demographics
NPI:1144425125
Name:BIRD, RAYMOND (SLT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:BIRD
Suffix:
Gender:M
Credentials:SLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1406
Mailing Address - Country:US
Mailing Address - Phone:607-754-6110
Mailing Address - Fax:
Practice Address - Street 1:6142 STATE HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3536
Practice Address - Country:US
Practice Address - Phone:607-337-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004811-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist