Provider Demographics
NPI:1164794152
Name:SPEECH LANGUAGE PATHOLOGIST BY OKSANA
Entity Type:Organization
Organization Name:SPEECH LANGUAGE PATHOLOGIST BY OKSANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLYUK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:212-767-9957
Mailing Address - Street 1:1916 AVENUE K
Mailing Address - Street 2:4C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4960
Mailing Address - Country:US
Mailing Address - Phone:212-767-9957
Mailing Address - Fax:718-377-1847
Practice Address - Street 1:1916 AVENUE K
Practice Address - Street 2:4C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4960
Practice Address - Country:US
Practice Address - Phone:212-767-9957
Practice Address - Fax:718-377-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019966252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency