Provider Demographics
NPI:1164732277
Name:BROOKLYN COLLEGE SPEECH AND HEARING CENTER
Entity Type:Organization
Organization Name:BROOKLYN COLLEGE SPEECH AND HEARING CENTER
Other - Org Name:DIANA ROGOVIN DAVIDOW SPEECH AND HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHNE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:718-951-5186
Mailing Address - Street 1:2900 BEDFORD AVE
Mailing Address - Street 2:ROOM 4400 BOYLAN HALL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2850
Mailing Address - Country:US
Mailing Address - Phone:718-951-5186
Mailing Address - Fax:718-951-4363
Practice Address - Street 1:2900 BEDFORD AVE
Practice Address - Street 2:ROOM 4400 BOYLAN HALL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2850
Practice Address - Country:US
Practice Address - Phone:718-951-5186
Practice Address - Fax:718-951-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty