Provider Demographics
NPI:1154846723
Name:SPENCER, KSENIYA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KSENIYA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KSENIYA
Other - Middle Name:
Other - Last Name:DZHANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6712 YELLOWSTONE BLVD APT D1
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2323
Mailing Address - Country:US
Mailing Address - Phone:646-596-6162
Mailing Address - Fax:
Practice Address - Street 1:200 W 135TH ST # 214
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2802
Practice Address - Country:US
Practice Address - Phone:212-283-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist