Provider Demographics
NPI:1164208708
Name:ZDOROVYAK, BEATRICE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:
Last Name:ZDOROVYAK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 HIGH RIDGE RD STE 290
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1203
Mailing Address - Country:US
Mailing Address - Phone:203-490-0355
Mailing Address - Fax:
Practice Address - Street 1:22 E FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-2110
Practice Address - Country:US
Practice Address - Phone:973-902-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01138000235Z00000X
CT18.007512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist