Provider Demographics
NPI:1174679468
Name:REESE, DARLENE ANNE (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:DARLENE
Middle Name:ANNE
Last Name:REESE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SUFFOLK LN
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2211
Mailing Address - Country:US
Mailing Address - Phone:631-581-6738
Mailing Address - Fax:
Practice Address - Street 1:51 SUFFOLK LN
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2211
Practice Address - Country:US
Practice Address - Phone:631-581-6738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008422-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist