Provider Demographics
NPI:1154864924
Name:KALISH, PHYLLIS LEFKOWITZ (MA,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:LEFKOWITZ
Last Name:KALISH
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:MRS
Other - First Name:PHYLLIS
Other - Middle Name:ESHER
Other - Last Name:KALISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:37 JEROLD ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3736
Mailing Address - Country:US
Mailing Address - Phone:718-268-3137
Mailing Address - Fax:
Practice Address - Street 1:6701 110TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2378
Practice Address - Country:US
Practice Address - Phone:718-268-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist