Provider Demographics
NPI:1154864544
Name:DE LA IGLESIA, ANA ISABEL
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ISABEL
Last Name:DE LA IGLESIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2217
Mailing Address - Country:US
Mailing Address - Phone:305-302-1866
Mailing Address - Fax:
Practice Address - Street 1:1633 E 8TH ST
Practice Address - Street 2:PS 231@238
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2217
Practice Address - Country:US
Practice Address - Phone:718-336-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist